Provider Demographics
NPI:1881365880
Name:GOMEZ BOHORQUEZ, MARIA DOLORES
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:DOLORES
Last Name:GOMEZ BOHORQUEZ
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 1:5759 PARKVIEW POINT DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-7963
Mailing Address - Country:US
Mailing Address - Phone:407-456-0461
Mailing Address - Fax:
Practice Address - Street 1:5759 PARKVIEW POINT DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32821-7963
Practice Address - Country:US
Practice Address - Phone:407-456-0461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND2799133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist