MEDICARE: RACIEL GOMEZ RODRIGUEZ

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	363LF0000X	Family Nurse Practitioner	9403991	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205203254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACIEL GOMEZ RODRIGUEZ

Provider Business Mailing Address
First Line	:	4867 GOLDEN GATE PKWY
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34116-6953
Country	:	US
Telephone Number	:	239-234-5623
Fax Number	:

Provider Business Practice Location Address
First Line	:	4867 GOLDEN GATE PKWY
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34116-6953
Country	:	US
Telephone Number	:	239-234-5623
Fax Number	:

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

Provider Enumeration Date	:	08/25/2015
Last Update Date	:	12/09/2015

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