Healthcare Provider Details

I. General information

NPI: 1467379412
Provider Name (Legal Business Name): MAISEL MARILU TRETO GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 SUNDIATA ST
PIEDMONT SC
29673-9992
US

IV. Provider business mailing address

1605 SUNDIATA ST
PIEDMONT SC
29673-9992
US

V. Phone/Fax

Practice location:
  • Phone: 786-201-8328
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number32216
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number32216
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: