Provider Demographics
NPI:1568131951
Name:GOMEZ JIMENEZ, DUVIER EDMUNDO SR
Entity Type:Individual
Prefix:DR
First Name:DUVIER
Middle Name:EDMUNDO
Last Name:GOMEZ JIMENEZ
Suffix:SR
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 1:13529 SW 8TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-1878
Mailing Address - Country:US
Mailing Address - Phone:305-798-3911
Mailing Address - Fax:305-906-6191
Practice Address - Street 1:13529 SW 8TH LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-1878
Practice Address - Country:US
Practice Address - Phone:305-798-3911
Practice Address - Fax:305-906-6191
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCMS101089171M00000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator