Provider Demographics
NPI:1134683220
Name:GONZALEZ, TANIA DIMARIS (MD)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:DIMARIS
Last Name:GONZALEZ
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 1:136 MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-3848
Mailing Address - Country:US
Mailing Address - Phone:786-438-9697
Mailing Address - Fax:
Practice Address - Street 1:1150 S SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-1460
Practice Address - Country:US
Practice Address - Phone:407-704-7811
Practice Address - Fax:407-382-0659
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional