Provider Demographics
NPI:1790549871
Name:GOMEZ-SANCHEZ, JUAN PABLO
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:PABLO
Last Name:GOMEZ-SANCHEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2558 JARDIN MNR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33327-1523
Mailing Address - Country:US
Mailing Address - Phone:561-866-8585
Mailing Address - Fax:
Practice Address - Street 1:2558 JARDIN MNR
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33327-1523
Practice Address - Country:US
Practice Address - Phone:561-866-8585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-325931106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician