Healthcare Provider Details

I. General information

NPI: 1912426008
Provider Name (Legal Business Name): ABELARDO GOTAY GUZMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3166 GRAND PAVILION DR
TAMPA FL
33613-3722
US

IV. Provider business mailing address

3166 GRAND PAVILION DR UNIT 204
TAMPA FL
33613-3722
US

V. Phone/Fax

Practice location:
  • Phone: 787-244-6831
  • Fax:
Mailing address:
  • Phone: 787-244-6831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number0243
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number2043
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: