Healthcare Provider Details

I. General information

NPI: 1558709154
Provider Name (Legal Business Name): EDUARDO A GONZALEZ MS, RD, LDN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2013
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 53RD AVE E
BRADENTON FL
34203-4801
US

IV. Provider business mailing address

101 RIVERFRONT BLVD STE 710
BRADENTON FL
34205-8823
US

V. Phone/Fax

Practice location:
  • Phone: 941-751-8100
  • Fax: 941-751-8127
Mailing address:
  • Phone: 941-776-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number007759
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND7605
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: