Provider Demographics
NPI:1568205201
Name:GOMEZ ALBUERNE, OMAR
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:GOMEZ ALBUERNE
Suffix:
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 1:7225 W 11TH CT APT 101
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4644
Mailing Address - Country:US
Mailing Address - Phone:786-216-6281
Mailing Address - Fax:
Practice Address - Street 1:7225 W 11TH CT APT 101
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-4644
Practice Address - Country:US
Practice Address - Phone:786-216-6281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-352072106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician