Individual
BENJAMIN JACOB GOMEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
2001 VICTOR WHARF, PEARL CITY, HI 96782
(954) 614-7005
Mailing address
2001 VICTOR WHARF, PEARL CITY, HI 96782
(954) 614-7005
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
—
—
1710I1002X
Independent Duty Corpsman
Primary
—
—
1710I1003X
Independent Duty Medical Technicians
—
—
261QM1102X
Military Outpatient Operational (Transportable) Component Clinic/Center
—
—
261QM1103X
Military Ambulatory Procedure Visits Operational (Transportable) Clinic/Center
—
—
286500000X
Military Hospital
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1384550807
DOD ID
IL
Enumeration date
09/05/2019
Last updated
12/17/2019
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