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General NPI Number Information
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NPI Number | 1689196248
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Entity Type | Organization
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Legal Business Name | VEIN & VASCULAR EXPERTS, PLLC
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Dates
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Enumeration Date | 07/14/2017
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 5325 US HWY 98 S
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City | LAKELAND
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State | FL
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Zip | 33812
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Country | US
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Telephone | 863-937-3139
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Fax | 863-937-3147
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Provider Business Mailing Address
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Address Line | PO BOX 1328
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City | HIGHLAND CITY
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State | FL
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Zip | 33846-1328
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Country | US
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Telephone | 863-937-3139
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Fax | 863-937-3147
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. GUSTAVO DE JESUS-GOMEZ
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Credential | MD
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Telephone | 863-937-3139
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | ME112008
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License Number State | FL
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