Provider Demographics
NPI:1558709154
Name:GONZALEZ, EDUARDO A (MS, RD, LDN)
Entity Type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:A
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7320 E FLETCHER AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33637-0916
Mailing Address - Country:US
Mailing Address - Phone:888-964-1975
Mailing Address - Fax:877-743-5351
Practice Address - Street 1:7320 E FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33637-0916
Practice Address - Country:US
Practice Address - Phone:888-964-1975
Practice Address - Fax:877-743-5351
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007759133V00000X, 133V00000X
FLND7605133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered