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Provider Information for 1336711522

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

ALEXEI GOMEZ

Gender: MALE

Individual NPI: 1336711522

Calendar   Last Updated:  2021-07-15
  Certification Date:  2021-07-15

Details

Name Value
NPI 1336711522
Enumeration Date 2021-07-15
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 13595 SW 134TH AVE STE 104
MIAMI, FL 33186-4579
United States

Phone: 786-864-1030 | Fax:
View Map External Link
Primary Practice Address 13595 SW 134TH AVE STE 104
MIAMI, FL 33186-4579
United States

Phone: 786-864-1030 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 261QM0801X - Clinic/Center Mental Health (Including Community Mental Health Center) FL LC12289