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General NPI Number Information
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NPI Number | 1538458153
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Entity Type | Organization
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Legal Business Name | MARIO GOMEZ MD PA
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Dates
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Enumeration Date | 04/05/2011
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Last Update Date | 04/05/2011
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Provider Practice Location Address
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Address Line | 925 NE 30TH TER SUITE 300
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City | HOMESTEAD
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State | FL
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Zip | 33033-7613
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Country | US
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Telephone | 786-256-4174
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Fax |
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Provider Business Mailing Address
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Address Line | 8775 SW 164 ST
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City | PALMETTO BAY
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State | FL
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Zip | 33157-3562
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Country | US
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Telephone | 786-256-4174
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARIO GOMEZ
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Credential | MD
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Telephone | 786-256-4174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME102113
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License Number State | FL
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