Basic Information
| Provider Information | |||||||||
| NPI: | 1699792333 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOMEZ-LUENGAS | ||||||||
| FirstName: | ALEXANDER | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 S PINE ISLAND RD | ||||||||
| Address2: | STE 800 | ||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333243920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055323378 | ||||||||
| FaxNumber: | 3055321164 | ||||||||
| Practice Location | |||||||||
| Address1: | 10710 STATE ROAD 54 | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | TRINITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346552263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273764040 | ||||||||
| FaxNumber: | 7273768824 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 09/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | ME96141 | FL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 275611100 | 05 | FL | MEDICAID |