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NPI Code Detail

MEDICARE: MIDDELIZA GOMEZ LORENZO

MEDICARE: MIDDELIZA GOMEZ LORENZO
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
1171M00000XCase Manager/Care CoordinatorCBHCM103793FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CBHCM103793OTHERFLFLORIDA CERTIFICATION BOARD

General Provider Information

NPI Number : 1194495671
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIDDELIZA GOMEZ LORENZO
Provider Business Mailing Address
First Line : 8180 NW 36TH ST STE 209
Second Line :
City : DORAL
State : FL
Zip : 33166-6653
Country : US
Telephone Number : 786-334-6946
Fax Number : 786-313-3079
Provider Business Practice Location Address
First Line : 8180 NW 36TH ST STE 209
Second Line :
City : DORAL
State : FL
Zip : 33166-6653
Country : US
Telephone Number : 786-334-6946
Fax Number : 786-313-3079
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2021
Last Update Date : 09/16/2021

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Directions to “ MIDDELIZA GOMEZ LORENZO ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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