MEDICARE: MARITZA GOMEZ

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	310400000X	Assisted Living Facility	6906456	FL

General Provider Information

NPI Number	:	1831437722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARITZA GOMEZ

Provider Business Mailing Address
First Line	:	13370 SW 82ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-4123
Country	:	US
Telephone Number	:	786-587-9060
Fax Number	:	786-362-6304

Provider Business Practice Location Address
First Line	:	13370 SW 82ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-4123
Country	:	US
Telephone Number	:	786-587-9060
Fax Number	:	786-362-6304

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MARITZA GOMEZ
Credential	:
Telephone Number	:	786-587-9060

Provider Enumeration Date	:	01/28/2013
Last Update Date	:	01/28/2013

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Directions to “MARITZA GOMEZ ” Practice Location

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