Healthcare Provider Details

I. General information

NPI: 1649137274
Provider Name (Legal Business Name): PAMELA GONZALEZ MARQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 COMMERCE CENTER DR
SAINT CLOUD FL
34769-1549
US

IV. Provider business mailing address

8017 NEW RIVER DR APT 17205
ORLANDO FL
32821-5493
US

V. Phone/Fax

Practice location:
  • Phone: 407-450-5985
  • Fax:
Mailing address:
  • Phone: 916-835-6169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4400
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: