Provider Demographics
NPI:1174145395
Name:GOMEZ SALDANA, GUILLERMO P
Entity type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:P
Last Name:GOMEZ SALDANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8545 SW 133RD PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4177
Mailing Address - Country:US
Mailing Address - Phone:786-250-9988
Mailing Address - Fax:
Practice Address - Street 1:8545 SW 133RD PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4177
Practice Address - Country:US
Practice Address - Phone:786-250-9988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician