Provider Demographics
NPI:1417679945
Name:BRITO GOMEZ, ANAY
Entity Type:Individual
Prefix:
First Name:ANAY
Middle Name:
Last Name:BRITO 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 1:2075 SW 122ND AVE APT 509
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7339
Mailing Address - Country:US
Mailing Address - Phone:323-286-9137
Mailing Address - Fax:
Practice Address - Street 1:2075 SW 122ND AVE APT 509
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-7339
Practice Address - Country:US
Practice Address - Phone:323-286-9137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-210473106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114200300Medicaid