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General NPI Number Information
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NPI Number | 1902455868
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Entity Type | Individual
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Provider Name | MRS. ELIZABETH GOMEZ
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Gender | Female
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Dates
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Enumeration Date | 09/04/2019
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Last Update Date | 09/04/2019
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Provider Practice Location Address
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Address Line | 1513 SW 2ND CT
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City | HOMESTEAD
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State | FL
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Zip | 33030-6675
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Country | US
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Telephone | 864-263-7837
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 W PALMETTO PARK RD
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City | BOCA RATON
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State | FL
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Zip | 33486-3417
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Country | US
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Telephone | 561-344-2275
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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