MEDICARE: FEDERICO ANTONIO GOMEZ

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	25-446978	FL

General Provider Information

NPI Number	:	1376431593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FEDERICO ANTONIO GOMEZ

Provider Business Mailing Address
First Line	:	1839 SE 27TH TER
Second Line	:
City	:	HOMESTEAD
State	:	FL
Zip	:	33035-2469
Country	:	US
Telephone Number	:	786-546-4809
Fax Number	:

Provider Business Practice Location Address
First Line	:	2157 SW 13TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-2930
Country	:	US
Telephone Number	:	786-546-4809
Fax Number	:

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

Provider Enumeration Date	:	06/26/2025
Last Update Date	:	06/26/2025

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Directions to “ FEDERICO ANTONIO GOMEZ ” Practice Location

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