Provider Demographics
NPI:1457247702
Name:GOMEZ ESCAMILLA, LUZ ANGELA
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:ANGELA
Last Name:GOMEZ ESCAMILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11850 HIALEAH GARDENS BLVD UNIT 123
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4280
Mailing Address - Country:US
Mailing Address - Phone:786-690-0045
Mailing Address - Fax:
Practice Address - Street 1:11850 HIALEAH GARDENS BLVD UNIT 123
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-4280
Practice Address - Country:US
Practice Address - Phone:786-690-0045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-14
Last Update Date:2025-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1201XEye and Vision Services ProvidersTechnician/TechnologistOptometric AssistantGroup - Multi-Specialty