Provider Demographics
NPI:1932534666
Name:DR. CARLOS C. GOMEZ & ASSOCIATES, PA
Entity Type:Organization
Organization Name:DR. CARLOS C. GOMEZ & ASSOCIATES, PA
Other - Org Name:CENTER FOR HUMAN FORMATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST /OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:CAMILO
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:786-879-7007
Mailing Address - Street 1:9495 SW 72ND AVENUE
Mailing Address - Street 2:SUITE B295
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33146
Mailing Address - Country:US
Mailing Address - Phone:786-879-7007
Mailing Address - Fax:786-221-3978
Practice Address - Street 1:9495 SW 72ND AVENUE
Practice Address - Street 2:SUITE B295
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173
Practice Address - Country:US
Practice Address - Phone:786-879-7007
Practice Address - Fax:786-221-3978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7327103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty