Provider Demographics
NPI:1205033677
Name:GOMEZ, RAMIRO D (MT)
Entity type:Individual
Prefix:MR
First Name:RAMIRO
Middle Name:D
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3403 NW 82ND AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1068
Mailing Address - Country:US
Mailing Address - Phone:305-477-6325
Mailing Address - Fax:305-477-6926
Practice Address - Street 1:3403 NW 82ND AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1068
Practice Address - Country:US
Practice Address - Phone:305-477-6325
Practice Address - Fax:305-477-6926
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA43120225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist