MEDICARE: DR. RONIE L GOMES

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	106H00000X	Marriage & Family Therapist		FL

General Provider Information

NPI Number	:	1205096385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONIE L GOMES

Provider Business Mailing Address
First Line	:	10437 SW 53RD ST
Second Line	:
City	:	COOPER CITY
State	:	FL
Zip	:	33328-5607
Country	:	US
Telephone Number	:	954-680-1630
Fax Number	:

Provider Business Practice Location Address
First Line	:	1061 W OAKLAND PARK BLVD
Second Line	:	SUITE 118
City	:	WILTON MANORS
State	:	FL
Zip	:	33311-1609
Country	:	US
Telephone Number	:	954-567-4175
Fax Number	:

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

Provider Enumeration Date	:	06/12/2008
Last Update Date	:	06/12/2008

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