Provider Demographics
NPI:1790003804
Name:GOMEZ, CARLOS E (TEM)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:E
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:TEM
Other - Prefix:MR
Other - First Name:CARLOS
Other - Middle Name:E
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:TEM
Mailing Address - Street 1:URB REPARTO DAGUEY CALLE 3 H6
Mailing Address - Street 2:PO BOX 742
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610
Mailing Address - Country:US
Mailing Address - Phone:787-228-4594
Mailing Address - Fax:
Practice Address - Street 1:2328 AVE ALBIZU CAMPOS
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:PR
Practice Address - Zip Code:00677-2435
Practice Address - Country:US
Practice Address - Phone:787-228-4594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic