Provider Demographics
NPI:1083794010
Name:GONZALEZ-MAYO, ALINA (MD)
Entity Type:Individual
Prefix:
First Name:ALINA
Middle Name:
Last Name:GONZALEZ-MAYO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6309 VISTA VERDE DR E
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33707-6910
Mailing Address - Country:US
Mailing Address - Phone:727-344-1813
Mailing Address - Fax:
Practice Address - Street 1:1201 5TH AVE N
Practice Address - Street 2:SUITE 305
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1400
Practice Address - Country:US
Practice Address - Phone:727-327-3737
Practice Address - Fax:727-825-1377
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL605232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL193129OtherWELLCARE
FL0538OtherBLUE CROSS BLUE SHIELD
FL193129OtherWELLCARE