Provider Demographics
NPI:1508854852
Name:GOMEZ, CESAR GERARDO (MD)
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:GERARDO
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 JC BORBON
Mailing Address - Street 2:STE 67 PMB 353
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5375
Mailing Address - Country:US
Mailing Address - Phone:787-630-0563
Mailing Address - Fax:787-439-2154
Practice Address - Street 1:#4ES-12 AVE. FRAGOSO
Practice Address - Street 2:VILLA FONTANA
Practice Address - City:CAROILINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-276-7006
Practice Address - Fax:787-276-7030
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15786208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR23406 GOOtherTRIPLE S
PR9570042OtherHUMANA
PR9570042OtherHUMANA
PRI-41950Medicare UPIN