Provider Demographics
NPI:1235435900
Name:GOMEZ, LUZ M
Entity Type:Individual
Prefix:MRS
First Name:LUZ
Middle Name:M
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LUZ
Other - Middle Name:MARIA
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:1830 S OCEAN DR
Mailing Address - Street 2:3303
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-7696
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4628
Practice Address - Country:US
Practice Address - Phone:305-787-1501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 58381225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist