MEDICARE: DR. OMAR GOMEZ-MEDINA M.D.

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	208100000X	Physical Medicine & Rehabilitation Physician	17595	PR
2	2081N0008X	Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician	17595	PR

General Provider Information

NPI Number	:	1538350848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OMAR GOMEZ-MEDINA M.D.

Provider Business Mailing Address
First Line	:	658 CALLE MIRAMAR
Second Line	:	APT 1201
City	:	SAN JUAN
State	:	PR
Zip	:	00907-3450
Country	:	US
Telephone Number	:	787-640-5362
Fax Number	:

Provider Business Practice Location Address
First Line	:	ID14 CALLE ALMACIGO
Second Line	:	EXT. ROYAL PALM
City	:	BAYAMON
State	:	PR
Zip	:	00956-3104
Country	:	US
Telephone Number	:	787-288-0808
Fax Number	:	787-288-0888

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

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	02/09/2015

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