Provider Demographics
NPI:1235132085
Name:DA COSTA GOMEZ, CAROL ANA (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANA
Last Name:DA COSTA GOMEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15671 SW 88TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1103
Mailing Address - Country:US
Mailing Address - Phone:305-752-6465
Mailing Address - Fax:305-752-6467
Practice Address - Street 1:15671 SW 88TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1103
Practice Address - Country:US
Practice Address - Phone:305-752-6465
Practice Address - Fax:305-752-6467
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL73650208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252757000Medicaid