Provider Demographics
NPI:1295742815
Name:GOMEZ, JOAQUIN A (MD)
Entity type:Individual
Prefix:DR
First Name:JOAQUIN
Middle Name:A
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2760 SW 97TH AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2684
Mailing Address - Country:US
Mailing Address - Phone:305-228-7120
Mailing Address - Fax:305-228-6153
Practice Address - Street 1:2760 SW 97TH AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2684
Practice Address - Country:US
Practice Address - Phone:305-228-7120
Practice Address - Fax:305-228-6153
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2011-09-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME75444208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254051700Medicaid