Provider Demographics
NPI:1780671891
Name:DE JESUS GOMEZ, RICARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:
Last Name:DE JESUS 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 1:1710 CARR 2
Mailing Address - Street 2:# INT167
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-6329
Mailing Address - Country:US
Mailing Address - Phone:787-785-8034
Mailing Address - Fax:
Practice Address - Street 1:1710 CARR 2 # INT167
Practice Address - Street 2:CONDOMINIO GALLARDO TOWERS SUITE 101
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6329
Practice Address - Country:US
Practice Address - Phone:787-785-8034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR158932085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology