Provider Demographics
NPI:1053003517
Name:GOMEZ, FLORDELIZA YACAP (DPT)
Entity type:Individual
Prefix:
First Name:FLORDELIZA
Middle Name:YACAP
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 DUSTY BRANCH LN
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19952-6423
Mailing Address - Country:US
Mailing Address - Phone:302-228-5458
Mailing Address - Fax:
Practice Address - Street 1:16 DUSTY BRANCH LN
Practice Address - Street 2:
Practice Address - City:HARRINGTON
Practice Address - State:DE
Practice Address - Zip Code:19952-6423
Practice Address - Country:US
Practice Address - Phone:302-228-5458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2024-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0003507208100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation