Provider Demographics
NPI:1043478860
Name:GOMEZ, GABRIELA (DENTAL LAB TECH)
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:DENTAL LAB TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242 SALT CLAY CT
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-6634
Mailing Address - Country:US
Mailing Address - Phone:813-453-0266
Mailing Address - Fax:800-507-2750
Practice Address - Street 1:1242 SALT CLAY CT
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6634
Practice Address - Country:US
Practice Address - Phone:813-990-0899
Practice Address - Fax:800-507-2750
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11273292200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes292200000XLaboratoriesDental Laboratory