Provider Demographics
NPI:1326088022
Name:GOMEZ, EDGAR ENRIQUE SR (BASIC X RAY TECH)
Entity Type:Individual
Prefix:MR
First Name:EDGAR
Middle Name:ENRIQUE
Last Name:GOMEZ
Suffix:SR
Gender:M
Credentials:BASIC X RAY TECH
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Mailing Address - Street 1:9220 FONTAINEBLEAU BLVD
Mailing Address - Street 2:503
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-4237
Mailing Address - Country:US
Mailing Address - Phone:786-514-2855
Mailing Address - Fax:
Practice Address - Street 1:711 NW 23RD AVE
Practice Address - Street 2:204
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3298
Practice Address - Country:US
Practice Address - Phone:305-541-2888
Practice Address - Fax:305-541-2879
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
FL48679247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL48679OtherXRAY MACHINE OPERATOR