Provider Demographics
NPI:1710226444
Name:GOMEZ, VLADIMIR L
Entity Type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:L
Last Name:GOMEZ
Suffix:
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 1:1275 W 47TH PL STE 303
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3447
Mailing Address - Country:US
Mailing Address - Phone:305-825-4320
Mailing Address - Fax:305-825-8117
Practice Address - Street 1:1275 W 47TH PL STE 303
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3447
Practice Address - Country:US
Practice Address - Phone:305-825-4320
Practice Address - Fax:305-825-8117
Is Sole Proprietor?:No
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker