1730755885 NPI number — MARINA TUYAS GONZALEZ

Table of content: MARINA TUYAS GONZALEZ (NPI 1730755885)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730755885 NPI number — MARINA TUYAS GONZALEZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TUYAS GONZALEZ
Provider First Name:
MARINA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1730755885
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/31/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5050 TAMIAMI TRL N STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAPLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34103-2853
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-351-4787
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3900 COLONIAL BLVD STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33966-1014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-351-3715
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/31/2021

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: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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