Healthcare Provider Details

I. General information

NPI: 1770159006
Provider Name (Legal Business Name): LUCY M ZUMETA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4733 W WATERS AVE APT 912
TAMPA FL
33614-1456
US

IV. Provider business mailing address

4733 W WATERS AVE APT 912
TAMPA FL
33614-1456
US

V. Phone/Fax

Practice location:
  • Phone: 813-450-7491
  • Fax:
Mailing address:
  • Phone: 813-450-7491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberZ532533895120
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: