Provider Demographics
NPI:1821253428
Name:GOMEZ, ANA MARIA (MD)
Entity Type:Individual
Prefix:
First Name:ANA MARIA
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
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:J22 CALLE J
Mailing Address - Street 2:VILLACAPARRA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2203
Mailing Address - Country:US
Mailing Address - Phone:310-926-8524
Mailing Address - Fax:
Practice Address - Street 1:CALLE F VEGAS JIMENEZ
Practice Address - Street 2:MANATI MEDICAL CENTER
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:310-926-8524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0207572085R0202X
CAA1101122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A1101120Medicaid
PRGA461ZMedicare PIN
CAGA461ZMedicare PIN