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General NPI Number Information
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NPI Number | 1558775791
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Entity Type | Individual
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Provider Name | NICOLE I GOMEZ DORATI
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Gender | Female
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Dates
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Enumeration Date | 06/16/2014
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Last Update Date | 09/12/2018
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Provider Practice Location Address
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Address Line | 2400 N ORANGE BLOSSOM TRL STE 302
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City | KISSIMMEE
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State | FL
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Zip | 34744-2308
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Country | US
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Telephone | 407-932-6193
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Fax | 407-932-6194
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Provider Business Mailing Address
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Address Line | 2400 N ORANGE BLOSSOM TRL STE 302
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City | KISSIMMEE
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State | FL
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Zip | 34744-2308
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Country | US
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Telephone | 407-932-6193
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Fax | 407-932-6194
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | ME135373
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License Number State | FL
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