Provider Demographics
NPI:1487390951
Name:GONZALEZ SOLIS, MARCO VINICIO (DO)
Entity type:Individual
Prefix:MR
First Name:MARCO
Middle Name:VINICIO
Last Name:GONZALEZ SOLIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 W WATERS AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-8133
Mailing Address - Country:US
Mailing Address - Phone:813-488-8231
Mailing Address - Fax:
Practice Address - Street 1:4040 W WATERS AVE STE 106
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-8133
Practice Address - Country:US
Practice Address - Phone:813-488-8231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO777156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician