MEDICARE: RAG MEDICAL CLINIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	207Q00000X	Family Medicine Physician
3	261QM1300X	Multi-Specialty Clinic/Center
4	261Q00000X	Clinic/Center
5	208D00000X	General Practice Physician
6	261QP2300X	Primary Care Clinic/Center
7	261QP3300X	Pain Clinic/Center
8	207RA0401X	Addiction Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1528624053
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAG MEDICAL CLINIC LLC

Provider Business Mailing Address
First Line	:	6408 N ARMENIA AVE STE B-1
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-5770
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6408 N ARMENIA AVE STE B-1
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-5770
Country	:	US
Telephone Number	:	813-352-8305
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	RICARDO A GOMEZ FERNANDEZ
Credential	:
Telephone Number	:	813-352-8305

Provider Enumeration Date	:	05/09/2019
Last Update Date	:	01/14/2026

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Directions to “RAG MEDICAL CLINIC LLC ” Practice Location

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