Provider Demographics
NPI:1528770807
Name:GONZALEZ MITIDIERI, MARIANA VICTORIA (PHARMD)
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:VICTORIA
Last Name:GONZALEZ MITIDIERI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 ASHWORTH OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-3348
Mailing Address - Country:US
Mailing Address - Phone:787-640-1017
Mailing Address - Fax:
Practice Address - Street 1:1401 S HIAWASSEE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5715
Practice Address - Country:US
Practice Address - Phone:407-295-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS65242183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist