MEDICARE: KENLLY GOMEZ MD

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	235Z00000X	Speech-Language Pathologist	SZ11933	FL

General Provider Information

NPI Number	:	1487496741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENLLY GOMEZ MD

Provider Business Mailing Address
First Line	:	5665 W 20TH AVE APT 208
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-7530
Country	:	US
Telephone Number	:	786-815-4240
Fax Number	:

Provider Business Practice Location Address
First Line	:	5665 W 20TH AVE APT 208
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-7530
Country	:	US
Telephone Number	:	786-815-4240
Fax Number	:

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

Provider Enumeration Date	:	06/08/2024
Last Update Date	:	06/08/2024

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Directions to “ KENLLY GOMEZ MD” Practice Location

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