MEDICARE: LEOBEN 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	172M00000X	Mechanotherapist

General Provider Information

NPI Number	:	1437490745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEOBEN GOMEZ

Provider Business Mailing Address
First Line	:	6841 NW 173RD DR APT 201
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-5575
Country	:	US
Telephone Number	:	786-294-8577
Fax Number	:

Provider Business Practice Location Address
First Line	:	6841 NW 173RD DR APT 201
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-5575
Country	:	US
Telephone Number	:	786-294-8577
Fax Number	:

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

Provider Enumeration Date	:	03/12/2013
Last Update Date	:	03/12/2013

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Directions to “ LEOBEN GOMEZ ” Practice Location

Language	Start Address	Practice Location

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