Provider Demographics
NPI:1427888502
Name:GOMEZ GARCIA, VICTOR ENMANUEL SR
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:ENMANUEL
Last Name:GOMEZ GARCIA
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13238 SW 287TH TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-7554
Mailing Address - Country:US
Mailing Address - Phone:844-513-9358
Mailing Address - Fax:
Practice Address - Street 1:5201 WATERFORD DISTRICT DR STE 836
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2647
Practice Address - Country:US
Practice Address - Phone:844-513-9358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH24551101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health