Healthcare Provider Details

I. General information

NPI: 1750074381
Provider Name (Legal Business Name): NERIEL GONZALEZ TAMAYO SA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2175 W 52ND ST APT 215
HIALEAH FL
33016-8201
US

IV. Provider business mailing address

2175 W 52ND ST APT 215
HIALEAH FL
33016-8201
US

V. Phone/Fax

Practice location:
  • Phone: 305-784-0012
  • Fax:
Mailing address:
  • Phone: 305-784-0012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number23-407
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number236155
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: