MEDICARE: GORKI GOMEZ MORAN

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	106S00000X	Behavior Technician	RBT-18-54401	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	:	1295220416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GORKI GOMEZ MORAN

Provider Business Mailing Address
First Line	:	991 E 18TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-4208
Country	:	US
Telephone Number	:	786-515-7239
Fax Number	:

Provider Business Practice Location Address
First Line	:	991 E 18TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-4208
Country	:	US
Telephone Number	:	786-515-7239
Fax Number	:

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

Provider Enumeration Date	:	06/29/2018
Last Update Date	:	06/29/2018

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