MEDICARE: JUANA GOMEZ MA

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	225700000X	Massage Therapist	MA 54966	FL

General Provider Information

NPI Number	:	1215177316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUANA GOMEZ MA

Provider Business Mailing Address
First Line	:	6106 DORY WAY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-3633
Country	:	US
Telephone Number	:	813-966-1832
Fax Number	:	813-932-6701

Provider Business Practice Location Address
First Line	:	1317 W. COLOMBUS DR.
Second Line	:	SUITE 208
City	:	TAMPA
State	:	FL
Zip	:	33607-1866
Country	:	US
Telephone Number	:	813-964-6829
Fax Number	:	813-964-6830

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

Provider Enumeration Date	:	03/02/2009
Last Update Date	:	10/13/2009

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Directions to “ JUANA GOMEZ MA” Practice Location

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