Provider Demographics
NPI:1871372201
Name:GARCIA GOMEZ, OLGA LUCIA (IBCLC, CERT DOULA)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:LUCIA
Last Name:GARCIA GOMEZ
Suffix:
Gender:F
Credentials:IBCLC, CERT DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4004 SW 26TH DR APT 33
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-7350
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4004 SW 26TH DR APT 33
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-7350
Practice Address - Country:US
Practice Address - Phone:352-222-5032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL-47030174N00000X
FL202308218374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN