Provider Demographics
NPI:1538419049
Name:GOMEZ GUILLEN, GERMAN (FMD)
Entity type:Individual
Prefix:
First Name:GERMAN
Middle Name:
Last Name:GOMEZ GUILLEN
Suffix:
Gender:M
Credentials:FMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9440 NW 35TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-2730
Mailing Address - Country:US
Mailing Address - Phone:786-339-3645
Mailing Address - Fax:
Practice Address - Street 1:3 SW 129TH AVE STE 203
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1779
Practice Address - Country:US
Practice Address - Phone:954-589-2539
Practice Address - Fax:954-374-9678
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker