Healthcare Provider Details

I. General information

NPI: 1013823582
Provider Name (Legal Business Name): VALERIA VICTORIA GONZALEZ SALAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4561 GLOBE THISTLE DR
TAMPA FL
33619-6955
US

IV. Provider business mailing address

4561 GLOBE THISTLE DR
TAMPA FL
33619-6955
US

V. Phone/Fax

Practice location:
  • Phone: 727-851-0683
  • Fax:
Mailing address:
  • Phone: 727-851-0683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: