Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NP0017X | Pediatric Chiropractor | NOT AVAILABLE | NY |
NPI | 1568768869 |
---|---|
Provider Name | Sandra Gomez |
First Address | Medley, FL 33178-2533 |
Second Address | South Miami, FL 33143-5000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2011 |
Last Update Date | 07/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CH11428 | CH LICENSE (01) | FL |