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General NPI Number Information
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NPI Number | 1457960502
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Entity Type | Individual
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Provider Name | MISS TAMARA PAOLA GONZALEZ COPO
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Gender | Female
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Dates
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Enumeration Date | 07/24/2020
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 4735 W RIVER DR NE
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City | COMSTOCK PARK
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State | MI
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Zip | 49321-9602
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Country | US
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Telephone | 616-784-9400
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Fax |
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Provider Business Mailing Address
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Address Line | 4735 W RIVER DR NE
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City | COMSTOCK PARK
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State | MI
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Zip | 49321-9602
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Country | US
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Telephone | 616-784-9400
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4351049611
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License Number State | MI
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