Provider Demographics
NPI:1407150766
Name:VILMA VICTORIA MERCHANT -GOMEZ
Entity Type:Organization
Organization Name:VILMA VICTORIA MERCHANT -GOMEZ
Other - Org Name:VILMA VICTORIA MERCHANT-GOMEZ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PATIENT CARE ATTENDANT
Authorized Official - Prefix:
Authorized Official - First Name:VILMA
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:MERCHANT -GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-344-8845
Mailing Address - Street 1:14719 SW 90TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1466
Mailing Address - Country:US
Mailing Address - Phone:786-344-8845
Mailing Address - Fax:
Practice Address - Street 1:14719 SW 90TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1466
Practice Address - Country:US
Practice Address - Phone:786-344-8845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-30
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL684128702Medicaid
FL684128703Medicaid