Provider Demographics
NPI:1285777870
Name:GOMEZ, ARLENE (MSPT)
Entity type:Individual
Prefix:MRS
First Name:ARLENE
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4722
Mailing Address - Country:US
Mailing Address - Phone:954-455-3883
Mailing Address - Fax:954-454-9802
Practice Address - Street 1:1920 E HALLANDALE BEACH BLVD
Practice Address - Street 2:SUITE 700
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4722
Practice Address - Country:US
Practice Address - Phone:954-455-3883
Practice Address - Fax:954-454-9802
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT14795174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAI120ZMedicare PIN