MEDICARE: ARIEL 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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1336016757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARIEL GOMEZ RODRIGUEZ

Provider Business Mailing Address
First Line	:	13506 FAWN RIDGE BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-2926
Country	:	US
Telephone Number	:	786-817-5307
Fax Number	:

Provider Business Practice Location Address
First Line	:	13506 FAWN RIDGE BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-2926
Country	:	US
Telephone Number	:	786-817-5307
Fax Number	:

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

Provider Enumeration Date	:	10/21/2025
Last Update Date	:	03/27/2026

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