Provider Demographics
NPI:1083006811
Name:GOMEZ-QUINTELA, JOSE LUIS (ARNP-CRNA)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:LUIS
Last Name:GOMEZ-QUINTELA
Suffix:
Gender:M
Credentials:ARNP-CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9655 S DIXIE HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2813
Mailing Address - Country:US
Mailing Address - Phone:786-370-4189
Mailing Address - Fax:
Practice Address - Street 1:9655 S DIXIE HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-2813
Practice Address - Country:US
Practice Address - Phone:786-370-4189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-03
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9302418367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered