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BENJAMIN JACOB GOMEZ IDC

Ambulatory Health Care Facilities Clinic/Center Military Outpatient Operational (Transportable) Component

Provider NPI: 1801445663

Provider Information:
 BENJAMIN JACOB GOMEZ IDC
Gender: M
Sole Proprietor

Practice Location:
2001 VICTOR WHARF  PEARL CITY, HI 96782 US
Tel: 954-614-7005  Fax: --

Business Mailing Address:
2001 VICTOR WHARF  PEARL CITY, HI 96782 US
Tel: 954-614-7005  Fax: --

NPI Information:
NPI: 1801445663
Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N261QM1102XAmbulatory Health Care Facilities
Clinic/Center
Military Outpatient Operational (Transportable) Component
N261QM1103XAmbulatory Health Care Facilities
Clinic/Center
N286500000XHospitals
Military Hospital
N171000000XOther Service Providers
Military Health Care Provider
Y1710I1002XOther Service Providers
Military Health Care Provider
N1710I1003XOther Service Providers
Military Health Care Provider

Other Provider Identifiers:

IssuerNumberStateType
DOD ID1384550807IL01



American Medical Association 2012 taxonomy code information

Code: 1710I1002X

Type:

Classification:



Definition:



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