Provider Demographics
NPI:1376297234
Name:GOMEZ, JESSENIA CARIDAD
Entity Type:Individual
Prefix:
First Name:JESSENIA
Middle Name:CARIDAD
Last Name:GOMEZ
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 1:20521 NW 46TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-1235
Mailing Address - Country:US
Mailing Address - Phone:786-444-6424
Mailing Address - Fax:
Practice Address - Street 1:15321 S DIXIE HWY STE 309
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1873
Practice Address - Country:US
Practice Address - Phone:786-732-7855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty