Provider Demographics
NPI:1740040054
Name:GOMEZ, DANIEL A (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:A
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2391 NW 96TH TER # 19H
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3045
Mailing Address - Country:US
Mailing Address - Phone:954-496-2828
Mailing Address - Fax:
Practice Address - Street 1:2391 NW 96TH TER # 19H
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-3045
Practice Address - Country:US
Practice Address - Phone:954-496-2828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program