Provider Demographics
NPI:1194930594
Name:PABLO A GOMEZ CORTES
Entity type:Organization
Organization Name:PABLO A GOMEZ CORTES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOMEZ CORTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-617-9110
Mailing Address - Street 1:137 CALLE HARRISON
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-1503
Mailing Address - Country:US
Mailing Address - Phone:787-617-9110
Mailing Address - Fax:787-890-0724
Practice Address - Street 1:CARR 467, KM. 4.4 INT.
Practice Address - Street 2:BO. CAMASEYES
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-617-9110
Practice Address - Fax:787-818-0429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC AMB 4113416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR89067OtherMMM
PR50749OtherPMC
PR8341OtherAMERICAN HEALTH MEDICARE
PR0058185Medicare PIN