Provider Demographics
NPI:1912426008
Name:GOTAY GUZMAN, ABELARDO
Entity type:Individual
Prefix:
First Name:ABELARDO
Middle Name:
Last Name:GOTAY GUZMAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3166 GRAND PAVILION DR UNIT 204
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3722
Mailing Address - Country:US
Mailing Address - Phone:787-244-6831
Mailing Address - Fax:
Practice Address - Street 1:3166 GRAND PAVILION DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3722
Practice Address - Country:US
Practice Address - Phone:787-244-6831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0243133N00000X
PR2043133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2043OtherOFFICE OF REGULATION AND CERTIFICATION OF HEATLH PROFESSIONALES OF PR
FLND14169OtherFLORIDA DEPARTMENT OF HEALTH