Provider Demographics
NPI:1467081067
Name:GOMEZ REXACH, ISAAC
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:GOMEZ REXACH
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 1:1016 26TH ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-6820
Mailing Address - Country:US
Mailing Address - Phone:727-743-3013
Mailing Address - Fax:
Practice Address - Street 1:5030 78TH AVE N STE 11
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-2406
Practice Address - Country:US
Practice Address - Phone:727-545-1273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2020-04-15
Deactivation Date:2020-04-06
Deactivation Code:
Reactivation Date:2020-04-15
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker