Provider Demographics
NPI:1124221130
Name:GONZALEZ
Entity Type:Organization
Organization Name:GONZALEZ
Other - Org Name:TOTAL HEALTH INJURY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:ALFRED
Authorized Official - Last Name:G0NZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:813-931-9800
Mailing Address - Street 1:1812 W WATERS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-1004
Mailing Address - Country:US
Mailing Address - Phone:813-931-9800
Mailing Address - Fax:813-425-2601
Practice Address - Street 1:1812 W WATERS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-1004
Practice Address - Country:US
Practice Address - Phone:813-931-9800
Practice Address - Fax:813-425-2601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty