Provider Demographics
NPI:1437757911
Name:GOMEZ, ARISTIDES MARCIAL
Entity Type:Individual
Prefix:
First Name:ARISTIDES
Middle Name:MARCIAL
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 1:10135 NW 127TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-7438
Mailing Address - Country:US
Mailing Address - Phone:786-269-4317
Mailing Address - Fax:
Practice Address - Street 1:10135 NW 127TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-7438
Practice Address - Country:US
Practice Address - Phone:786-269-4317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management