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Organization
GOMEZ CLINIC CORP
Active
Organization
GOMEZ CLINIC CORP
Active
Other names
GOMEZ CLINIC CORP
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC CAMPILLO PMHNP (DIRECTOR)
(305) 300-5551
Entity
Organization
Contact information
Practice address
6583 SW 39TH TER STE B, MIAMI, FL 33155-4821
(786) 747-4949
(786) 756-1010
Mailing address
6583 SW 39TH TER STE B, MIAMI, FL 33155-4821
(305) 300-5551
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116427200
—
FL
Enumeration date
12/08/2022
Last updated
03/24/2025
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