Provider Demographics
NPI:1205637691
Name:ECHEVARRIA GOMEZ, HEILY
Entity type:Individual
Prefix:
First Name:HEILY
Middle Name:
Last Name:ECHEVARRIA GOMEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5728 SW 119TH AVE
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33330-3347
Mailing Address - Country:US
Mailing Address - Phone:954-224-0383
Mailing Address - Fax:
Practice Address - Street 1:5728 SW 119TH AVE
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33330-3347
Practice Address - Country:US
Practice Address - Phone:954-224-0383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty