Provider Demographics
NPI:1760073662
Name:GOMEZ, PATRICIA CELENE (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:CELENE
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17628 SW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-4850
Mailing Address - Country:US
Mailing Address - Phone:973-800-0107
Mailing Address - Fax:
Practice Address - Street 1:1436 E ATLANTIC BLVD STE F614
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-6758
Practice Address - Country:US
Practice Address - Phone:954-941-4000
Practice Address - Fax:954-941-4005
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13355111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor