MEDICARE: DARIO GONZALEZ ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	AL4893	FL

General Provider Information

NPI Number	:	1053826347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARIO GONZALEZ ATC

Provider Business Mailing Address
First Line	:	2125 W HIAWATHA ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-5732
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7561 BLACKBIRD ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33621-1007
Country	:	US
Telephone Number	:	402-641-0630
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2017
Last Update Date	:	01/29/2026

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