Provider Demographics
NPI:1437490745
Name:GOMEZ, LEOBEN
Entity Type:Individual
Prefix:
First Name:LEOBEN
Middle Name:
Last Name:GOMEZ
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 1:6841 NW 173RD DR APT 201
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5575
Mailing Address - Country:US
Mailing Address - Phone:786-294-8577
Mailing Address - Fax:
Practice Address - Street 1:6841 NW 173RD DR APT 201
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5575
Practice Address - Country:US
Practice Address - Phone:786-294-8577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist