Provider Demographics
NPI:1679805998
Name:ANGELA GOMEZ MD PA
Entity type:Organization
Organization Name:ANGELA GOMEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-444-7779
Mailing Address - Street 1:747 PONCE DE LEON BLVD
Mailing Address - Street 2:SUITE 606
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2074
Mailing Address - Country:US
Mailing Address - Phone:305-444-7779
Mailing Address - Fax:305-444-7290
Practice Address - Street 1:747 PONCE DE LEON BLVD
Practice Address - Street 2:SUITE 606
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2074
Practice Address - Country:US
Practice Address - Phone:305-444-7779
Practice Address - Fax:305-444-7290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-11
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82920207RE0101X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262760400Medicaid
FL262760400Medicaid