1023751708 NPI number — DR. TAVIA ISAURA GONZALEZ PENA MD, MPH

Table of content: DR. TAVIA ISAURA GONZALEZ PENA MD, MPH (NPI 1023751708)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023751708 NPI number — DR. TAVIA ISAURA GONZALEZ PENA MD, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ PENA
Provider First Name:
TAVIA
Provider Middle Name:
ISAURA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, MPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023751708
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1161 21ST AVE S
Provider Second Line Business Mailing Address:
B1124 MEDICAL CENTER NORTH
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37232-2521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-322-7484
Provider Business Mailing Address Fax Number:
615-343-8806

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1161 21ST AVE S
Provider Second Line Business Practice Location Address:
R-1200 MEDICAL CENTER NORTH
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37232-2521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-322-7484
Provider Business Practice Location Address Fax Number:
615-343-8806
Provider Enumeration Date:
04/19/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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