Provider Demographics
NPI:1245274232
Name:GOMEZ, MANUEL JOAQUIN (MD)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:JOAQUIN
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91550 OVERSEAS HWY STE 209
Mailing Address - Street 2:
Mailing Address - City:TAVERNIER
Mailing Address - State:FL
Mailing Address - Zip Code:33070-2513
Mailing Address - Country:US
Mailing Address - Phone:305-853-0558
Mailing Address - Fax:305-853-0744
Practice Address - Street 1:91550 OVERSEAS HWY STE 209
Practice Address - Street 2:
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-2513
Practice Address - Country:US
Practice Address - Phone:305-853-0558
Practice Address - Fax:305-853-0744
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92538208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME92538OtherMEDICAL DOCTOR
FL021675800Medicaid
FL021675800Medicaid