Provider Demographics
NPI:1770638637
Name:GOMEZ, CARLOS CAMILO (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:CAMILO
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:CARLOS
Other - Middle Name:
Other - Last Name:GOMEZ-ESTEFAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1390 S DIXIE HWY STE 2107
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2944
Mailing Address - Country:US
Mailing Address - Phone:786-622-2226
Mailing Address - Fax:
Practice Address - Street 1:301 ALMERIA AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134
Practice Address - Country:US
Practice Address - Phone:786-897-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7327103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist