Provider Demographics
NPI:1013040583
Name:ANA L. GOMEZ, PSY.D. P.A.
Entity Type:Organization
Organization Name:ANA L. GOMEZ, PSY.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:407-927-8154
Mailing Address - Street 1:202 LOOKOUT PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4488
Mailing Address - Country:US
Mailing Address - Phone:407-927-8154
Mailing Address - Fax:
Practice Address - Street 1:202 LOOKOUT PL
Practice Address - Street 2:SUITE 100
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4488
Practice Address - Country:US
Practice Address - Phone:407-927-8154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6628103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty