Provider Demographics
NPI:1346035565
Name:GOMEZ MARIN, FLAVIA ALEJANDRA
Entity type:Individual
Prefix:
First Name:FLAVIA
Middle Name:ALEJANDRA
Last Name:GOMEZ MARIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 NW 49TH CT
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-2451
Mailing Address - Country:US
Mailing Address - Phone:954-716-4594
Mailing Address - Fax:
Practice Address - Street 1:305 NW 49TH CT
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-2451
Practice Address - Country:US
Practice Address - Phone:954-716-4594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL929498106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician