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NPI Code Detail

MEDICARE: DR. JUAN MANUEL DANGOND GOMEZ DO

MEDICARE: DR. JUAN MANUEL DANGOND GOMEZ DO
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
1390200000XStudent in an Organized Health Care Education/Training Program
2207Q00000XFamily Medicine PhysicianOS19968FL

General Provider Information

NPI Number : 1467073254
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JUAN MANUEL DANGOND GOMEZ DO
Provider Business Mailing Address
First Line : 8750 SW 144TH ST STE 100
Second Line :
City : PALMETTO BAY
State : FL
Zip : 33176-7229
Country : US
Telephone Number : 786-596-3840
Fax Number :
Provider Business Practice Location Address
First Line : 8750 SW 144TH ST STE 100
Second Line :
City : PALMETTO BAY
State : FL
Zip : 33176-7229
Country : US
Telephone Number : 786-596-3840
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2020
Last Update Date : 06/10/2023

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