Provider Demographics
NPI:1710994736
Name:GOMEZ, ALVARO AGUSTO (MD)
Entity Type:Individual
Prefix:DR
First Name:ALVARO
Middle Name:AGUSTO
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 198054
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8054
Mailing Address - Country:US
Mailing Address - Phone:786-594-6880
Mailing Address - Fax:
Practice Address - Street 1:7400 SW 87 AVENUE
Practice Address - Street 2:SUITE #100
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173
Practice Address - Country:US
Practice Address - Phone:305-275-8200
Practice Address - Fax:305-274-7812
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64125207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373339400Medicaid
FL373339400Medicaid
F63779Medicare UPIN