Provider Demographics
NPI:1407509789
Name:GOMEZ PEREZ, ALBERTO
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:
Last Name:GOMEZ PEREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 NW 190TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-3904
Mailing Address - Country:US
Mailing Address - Phone:783-339-7824
Mailing Address - Fax:
Practice Address - Street 1:365 NW 190TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-3904
Practice Address - Country:US
Practice Address - Phone:783-339-7824
Practice Address - Fax:305-907-5343
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL95545247100000X
FLCRT955452471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist