Provider Demographics
NPI:1730621392
Name:GOMEZ, MEILY
Entity type:Individual
Prefix:
First Name:MEILY
Middle Name:
Last Name:GOMEZ
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 1:8340 NW 32ND CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-3902
Mailing Address - Country:US
Mailing Address - Phone:786-768-1744
Mailing Address - Fax:305-901-1797
Practice Address - Street 1:8340 NW 32ND CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-3902
Practice Address - Country:US
Practice Address - Phone:786-768-1744
Practice Address - Fax:305-901-1797
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician