Provider Demographics
NPI:1285891754
Name:GOMEZ DE VARGAS, MENCIA (MD)
Entity type:Individual
Prefix:
First Name:MENCIA
Middle Name:
Last Name:GOMEZ DE VARGAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1946 TYLER ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-4517
Mailing Address - Country:US
Mailing Address - Phone:754-333-9815
Mailing Address - Fax:571-386-2627
Practice Address - Street 1:1946 TYLER ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4517
Practice Address - Country:US
Practice Address - Phone:754-227-3373
Practice Address - Fax:571-386-2627
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1219552084P0015X, 2084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine