MEDICARE: MS. EMIRZAY DE JESUS GOMEZ GARRIDO

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	106S00000X	Behavior Technician		FL

General Provider Information

NPI Number	:	1679405062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EMIRZAY DE JESUS GOMEZ GARRIDO

Provider Business Mailing Address
First Line	:	1105 CORAL CLUB DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-5660
Country	:	US
Telephone Number	:	954-625-9918
Fax Number	:

Provider Business Practice Location Address
First Line	:	471 SW 134TH AVE
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33325-3100
Country	:	US
Telephone Number	:	954-625-9918
Fax Number	:

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

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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