Healthcare Provider Details

I. General information

NPI: 1336646587
Provider Name (Legal Business Name): GARCIA&GONZALEZLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7206 N ARMENIA AVE
TAMPA FL
33604-5201
US

IV. Provider business mailing address

7206 N ARMENIA AVE
TAMPA FL
33604-5201
US

V. Phone/Fax

Practice location:
  • Phone: 813-933-2880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIO JORGE GONZALEZ
Title or Position: OWNER
Credential: MD
Phone: 813-775-5429