MEDICARE: EDUARDO GOMEZ CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	1366882	FL

General Provider Information

NPI Number	:	1124328851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDUARDO GOMEZ CRNA

Provider Business Mailing Address
First Line	:	2047 NE 121ST RD
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-3306
Country	:	US
Telephone Number	:	305-951-8371
Fax Number	:	305-868-3731

Provider Business Practice Location Address
First Line	:	2047 NE 121ST RD
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-3306
Country	:	US
Telephone Number	:	305-951-8371
Fax Number	:	305-868-3731

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2010
Last Update Date	:	09/03/2013

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