Healthcare Provider Details

I. General information

NPI: 1750216305
Provider Name (Legal Business Name): DIANA MARCELA GONZALES PSY.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 W BRANDON BLVD STE 101
BRANDON FL
33511-4129
US

IV. Provider business mailing address

10501 LAGUNA PLAINS DR
RIVERVIEW FL
33578-0046
US

V. Phone/Fax

Practice location:
  • Phone: 813-586-1683
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS1982
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: