Provider Demographics
NPI:1770036881
Name:GOMEZ ABANTO, JULIANA BERTHA D (MD)
Entity type:Individual
Prefix:
First Name:JULIANA
Middle Name:BERTHA D
Last Name:GOMEZ ABANTO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3102 4TH ST APT W122
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79415-3234
Mailing Address - Country:US
Mailing Address - Phone:806-507-0366
Mailing Address - Fax:
Practice Address - Street 1:11215 METRO PKWY STE 100
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-1206
Practice Address - Country:US
Practice Address - Phone:239-208-2212
Practice Address - Fax:239-208-3994
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-26
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXBP100561082084N0400X
FLME1702542084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology