1326088022 NPI number — MR. EDGAR ENRIQUE GOMEZ SR. BASIC X RAY TECH

Table of content: MR. EDGAR ENRIQUE GOMEZ SR. BASIC X RAY TECH (NPI 1326088022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326088022 NPI number — MR. EDGAR ENRIQUE GOMEZ SR. BASIC X RAY TECH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOMEZ
Provider First Name:
EDGAR
Provider Middle Name:
ENRIQUE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
BASIC X RAY TECH
Provider Gender Code:
M

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:
1326088022
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9220 FONTAINEBLEAU BLVD
Provider Second Line Business Mailing Address:
503
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33172-4237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-514-2855
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
711 NW 23RD AVE
Provider Second Line Business Practice Location Address:
204
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33125-3298
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-541-2888
Provider Business Practice Location Address Fax Number:
305-541-2879
Provider Enumeration Date:
06/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 247100000X , with the licence number:  48679 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 48679 . This is a "XRAY MACHINE OPERATOR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com