Organization
SU SALUD CLINIC PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARIO AUGUSTO GOMEZ MD (FAMILY PRACTICE/OWNER)
(260) 444-5695
Entity
Organization
Contact information
Practice address
4101 DIPLOMAT PLAZA CTR, FORT WAYNE, IN 46806-4531
(260) 444-5695
(260) 444-5665
Mailing address
4101 DIPLOMAT PLAZA CTR, FORT WAYNE, IN 46806-4531
(260) 444-5695
(260) 444-5665
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01056928A
IN
Other
Enumeration date
11/30/2011
Last updated
07/16/2012
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