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General NPI Number Information
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NPI Number | 1821153115
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Entity Type | Individual
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Provider Name | DR. JOSE ANTONIO GOMEZ
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Gender | Male
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 12/14/2011
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Provider Practice Location Address
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Address Line | 9 CALLE FLOR GERENA N
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City | HUMACAO
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State | PR
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Zip | 00791-4288
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Country | US
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Telephone | 787-850-7500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 196
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City | LAS PIEDRAS
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State | PR
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Zip | 00771-0196
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Country | US
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Telephone | 787-850-7500
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 6264
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License Number State | PR
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