Basic Information
| Provider Information | |||||||||
| NPI: | 1437139292 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOMEZ | ||||||||
| FirstName: | ALFREDO | ||||||||
| MiddleName: | F. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1986 NE 35TH CT | ||||||||
| Address2: | |||||||||
| City: | OAKLAND PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333086255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542530932 | ||||||||
| FaxNumber: | 9542530932 | ||||||||
| Practice Location | |||||||||
| Address1: | 1725 N UNIVERSITY DR | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330716089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542277760 | ||||||||
| FaxNumber: | 9542279975 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2006 | ||||||||
| LastUpdateDate: | 04/19/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | ARNP 2515132 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | G2239 | 01 | FL | BCBS OF FLORIDA | OTHER | 430050723 | 01 | FL | RAILROAD MEDICARE | OTHER | 302363000 | 05 | FL | MEDICAID |