Provider Demographics
NPI:1639762586
Name:GOMEZ, AMALIA (CPT)
Entity Type:Individual
Prefix:
First Name:AMALIA
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:AMALIA
Other - Middle Name:
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:535 CLOUDCROFT DR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-9279
Mailing Address - Country:US
Mailing Address - Phone:074-777-1711
Mailing Address - Fax:
Practice Address - Street 1:535 CLOUDCROFT DR
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-9279
Practice Address - Country:US
Practice Address - Phone:407-777-1711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty