Provider Demographics
NPI:1497290746
Name:GOMEZ, LINO (LMT)
Entity Type:Individual
Prefix:
First Name:LINO
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N17 CALLE ESMERALDA
Mailing Address - Street 2:URB.MADELAINE
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-3566
Mailing Address - Country:US
Mailing Address - Phone:787-367-6400
Mailing Address - Fax:
Practice Address - Street 1:N17 CALLE ESMERALDA
Practice Address - Street 2:URB.MADELAINE
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-3566
Practice Address - Country:US
Practice Address - Phone:787-367-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0771173C00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist