1215181318 NPI number — MARIA R GOMEZ MD PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215181318 NPI number — MARIA R GOMEZ MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARIA R GOMEZ MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215181318
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
302 N DALE MABRY HWY
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33609-1249
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-873-2663
Provider Business Mailing Address Fax Number:
813-873-7001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 N DALE MABRY HWY
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33609-1249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-873-2663
Provider Business Practice Location Address Fax Number:
813-873-7001
Provider Enumeration Date:
11/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GOMEZ
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
ROSARIO
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
813-873-2663

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 045372200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 79920 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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