Provider Demographics
NPI:1881472322
Name:IZQUIERDO GOMEZ, OLMEDO (MSW)
Entity type:Individual
Prefix:
First Name:OLMEDO
Middle Name:
Last Name:IZQUIERDO GOMEZ
Suffix:
Gender:
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 OLD WINTER GARDEN RD APT 2712
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4537
Mailing Address - Country:US
Mailing Address - Phone:407-723-3387
Mailing Address - Fax:
Practice Address - Street 1:4700 MILLENIA BLVD STE 500
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-6019
Practice Address - Country:US
Practice Address - Phone:407-697-3266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2025-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty