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General NPI Number Information
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NPI Number | 1538350848
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Entity Type | Individual
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Provider Name | OMAR GOMEZ-MEDINA M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 02/09/2015
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Provider Practice Location Address
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Address Line | ID14 CALLE ALMACIGO EXT. ROYAL PALM
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City | BAYAMON
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State | PR
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Zip | 00956-3104
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Country | US
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Telephone | 787-288-0808
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Fax | 787-288-0888
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Provider Business Mailing Address
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Address Line | 658 CALLE MIRAMAR APT 1201
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City | SAN JUAN
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State | PR
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Zip | 00907-3450
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Country | US
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Telephone | 787-640-5362
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 17595
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 2081N0008X
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Taxonomy Name | Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 17595
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License Number State | PR
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