Healthcare Provider Details

I. General information

NPI: 1134683220
Provider Name (Legal Business Name): TANIA DIMARIS GONZALEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 S SEMORAN BLVD
ORLANDO FL
32807-1460
US

IV. Provider business mailing address

136 MERIDIAN ST
DAVENPORT FL
33837-3848
US

V. Phone/Fax

Practice location:
  • Phone: 407-704-7811
  • Fax: 407-382-0659
Mailing address:
  • Phone: 786-438-9697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: