Provider Demographics
NPI:1447366299
Name:GOMEZ-RIVERA, JOSE ALEJANDRO (DO)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ALEJANDRO
Last Name:GOMEZ-RIVERA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9485 SW 72ND ST
Mailing Address - Street 2:A-104
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3242
Mailing Address - Country:US
Mailing Address - Phone:305-270-1142
Mailing Address - Fax:305-270-1151
Practice Address - Street 1:9485 SW 72ND ST
Practice Address - Street 2:A-104
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3242
Practice Address - Country:US
Practice Address - Phone:305-270-1142
Practice Address - Fax:305-270-1151
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6658207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378322700Medicaid
FL57203AMedicare ID - Type Unspecified
FL378322700Medicaid