Provider Demographics
NPI:1134235807
Name:FAMILY MEDICINE OF MIAMI,P.A.
Entity type:Organization
Organization Name:FAMILY MEDICINE OF MIAMI,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ALEJANDRO
Authorized Official - Last Name:GOMEZ-RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-270-1142
Mailing Address - Street 1:9485 SW 72ND ST
Mailing Address - Street 2:A-104
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3242
Mailing Address - Country:US
Mailing Address - Phone:305-270-1142
Mailing Address - Fax:305-270-1151
Practice Address - Street 1:9485 SW 72ND ST
Practice Address - Street 2:A-104
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3242
Practice Address - Country:US
Practice Address - Phone:305-270-1142
Practice Address - Fax:305-270-1151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6658207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378322700Medicaid
FLG12875Medicare UPIN
FL378322700Medicaid