Provider Demographics
NPI:1639513450
Name:OSSA GOMEZ, PAOLA CATALINA
Entity Type:Individual
Prefix:
First Name:PAOLA
Middle Name:CATALINA
Last Name:OSSA GOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5945 SW 134TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7207
Mailing Address - Country:US
Mailing Address - Phone:305-332-8575
Mailing Address - Fax:
Practice Address - Street 1:5945 SW 134TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7207
Practice Address - Country:US
Practice Address - Phone:305-332-8575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21589122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist