Provider Demographics
NPI:1356127658
Name:GOMEZ SILVA, MARIA LAURA (SA-C)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:LAURA
Last Name:GOMEZ SILVA
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4828 CYPRESS WOODS DR APT 374
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-3518
Mailing Address - Country:US
Mailing Address - Phone:407-770-4004
Mailing Address - Fax:
Practice Address - Street 1:4828 CYPRESS WOODS DR APT 374
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-3518
Practice Address - Country:US
Practice Address - Phone:407-770-4004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-599246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant