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General NPI Number Information
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NPI Number | 1194836825
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Entity Type | Individual
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Provider Name | MARIEL GONZALEZ-MENDOZA MD
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 1305 CLEVELAND AVE STE G
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City | WILDWOOD
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State | FL
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Zip | 34785-3605
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Country | US
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Telephone | 352-913-2145
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Fax | 352-913-2146
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Provider Business Mailing Address
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Address Line | 601 S HARBOUR ISLAND BLVD STE 200
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City | TAMPA
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State | FL
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Zip | 33602-5925
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Country | US
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Telephone | 800-480-5243
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Fax | 800-928-7449
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME90507
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License Number State | FL
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