Provider Demographics
NPI:1780731463
Name:GOMEZ PERSONAL INJURY CLINIC INC
Entity type:Organization
Organization Name:GOMEZ PERSONAL INJURY CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EULOGIO
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:813-876-1690
Mailing Address - Street 1:4602 N ARMENIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-2703
Mailing Address - Country:US
Mailing Address - Phone:813-876-1690
Mailing Address - Fax:813-876-1653
Practice Address - Street 1:4602 N ARMENIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-2703
Practice Address - Country:US
Practice Address - Phone:813-876-1690
Practice Address - Fax:813-876-1690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6681261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center