Provider Information for 1275914111
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DIEGO FERNANDO GOMEZ LCAS-A
Sex: Male
NPI: 1275914111
Last Updated: 2020-09-03
Certification Date: 2020-09-03
Certification Date: 2020-09-03
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1275914111 | ||||||||
| Enumeration Date | 2015-06-16 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | PO BOX 2147 FORT MYERS, FL 33902-2147 United States Phone: 239-343-6050 | Fax:239-343-6051 | ||||||||
| Primary Practice Address | 15901 BASS RD STE 108 FORT MYERS, FL 33908 United States Phone: 239-343-6050 | Fax:239-343-6051 | ||||||||
| Secondary Practice Address(es) | 229 TURNER DR | ||||||||
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