Provider Demographics
NPI:1720164064
Name:GOMEZ, ANGELA A (MD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:A
Last Name:GOMEZ
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 1:747 PONCE DE LEON BLVD
Mailing Address - Street 2:SUITE 606
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2049
Mailing Address - Country:US
Mailing Address - Phone:305-444-7779
Mailing Address - Fax:305-444-7290
Practice Address - Street 1:747 PONCE DE LEON BLVD
Practice Address - Street 2:SUITE 606
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2049
Practice Address - Country:US
Practice Address - Phone:305-444-7779
Practice Address - Fax:305-444-7290
Is Sole Proprietor?:No
Enumeration Date:2006-10-30
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82820207RE0101X
FLME82920207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262760400Medicaid
FLE6734Medicare ID - Type Unspecified
E6734ZMedicare PIN
FL262760400Medicaid