=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912851460
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GERARDO TINAJERO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2026
-----------------------------------------------------
Last Update Date | 02/23/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 510 VONDERBURG DR STE 213
-----------------------------------------------------
City | BRANDON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33511-5981
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-347-8483
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5606 MACALLAN DR
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33625-1325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-450-9262
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 22697
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------