Provider Demographics
NPI:1619698230
Name:GOMES SARMENTO, MARCOS JEFFERSON (SA-C)
Entity Type:Individual
Prefix:
First Name:MARCOS
Middle Name:JEFFERSON
Last Name:GOMES SARMENTO
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 CLARKS SUMMIT CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-6602
Mailing Address - Country:US
Mailing Address - Phone:321-504-1000
Mailing Address - Fax:
Practice Address - Street 1:1431 CLARKS SUMMIT CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-6602
Practice Address - Country:US
Practice Address - Phone:321-504-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21-221246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant