Provider Demographics
NPI:1093417156
Name:GOMEZ, PABLO JOAQUIN
Entity Type:Individual
Prefix:
First Name:PABLO
Middle Name:JOAQUIN
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EUGENIO VELEZ
Mailing Address - Street 2:SANTA BARBARA
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-9764
Mailing Address - Country:US
Mailing Address - Phone:787-586-4959
Mailing Address - Fax:
Practice Address - Street 1:1 EUGENIO VELEZ
Practice Address - Street 2:SANTA BARBARA
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778-0077
Practice Address - Country:US
Practice Address - Phone:787-586-4959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-21
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZDQ2022103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth