Provider Demographics
NPI:1326791898
Name:GOMES, GLADYS ELISA
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:ELISA
Last Name:GOMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2838 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-3834
Mailing Address - Country:US
Mailing Address - Phone:954-920-8669
Mailing Address - Fax:
Practice Address - Street 1:2838 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-3834
Practice Address - Country:US
Practice Address - Phone:954-920-8669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant