MEDICARE: GOMEZ CLINIC CORP

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	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	103K00000X	Behavior Analyst

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	:	1477264695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOMEZ CLINIC CORP

Provider Business Mailing Address
First Line	:	6583 SW 39TH TER STE B
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-4821
Country	:	US
Telephone Number	:	305-300-5551
Fax Number	:

Provider Business Practice Location Address
First Line	:	6583 SW 39TH TER STE B
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-4821
Country	:	US
Telephone Number	:	786-747-4949
Fax Number	:	786-756-1010

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ERIC CAMPILLO
Credential	:	PMHNP
Telephone Number	:	305-300-5551

Provider Enumeration Date	:	12/08/2022
Last Update Date	:	03/24/2025

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Directions to “GOMEZ CLINIC CORP ” Practice Location

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