Gomez, Diego Fernando
Gomez, Diego Fernando is an individual health care provider with primary practice located at 15901 Bass Rd Ste 108 , Fort Myers FL 33908. He recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as his primary health care specialty. Gomez, Diego Fernando can be contacted via phone (239) 343-6050.Contact Information
Primary practice address
15901 Bass Rd Ste 108
Fort Myers FL 33908
Phone: (239) 343-6050
Fax: (239) 343-6051
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | MH14194 | Florida |
Profile Details
| NPI number | 1275914111 |
|---|---|
| LBN Legal business name | Gomez, Diego Fernando |
| Credentials | LCAS-A |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 16th, 2015 |
| Last updated | Sep 3rd, 2020 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1275914111 | NPPES |
| Florida | MEDICAID | 100799300 |
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