Provider Demographics
NPI:1780397299
Name:GOMEZ MILLAN, AURORA (CBHCM)
Entity type:Individual
Prefix:
First Name:AURORA
Middle Name:
Last Name:GOMEZ MILLAN
Suffix:
Gender:F
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8909 ROSEBANK CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-5710
Mailing Address - Country:US
Mailing Address - Phone:786-252-0686
Mailing Address - Fax:
Practice Address - Street 1:8909 ROSEBANK CT
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-5710
Practice Address - Country:US
Practice Address - Phone:786-252-0686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-29
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator