Active NPI
Tessa Vera Gonzalez, MD
- Pediatrics Physician
- Columbia, SC
National Provider Identifier
1740577469
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- LL33831
- Practice address
- 1228 Harden St
Columbia, SC 29204-1800 - Phone
- (803) 748-7002
- Fax
- (803) 252-5259
- NPI assigned
- Jul 1, 2011
- Last updated
- Apr 25, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | LL33831 | SC | Primary |
Addresses
Primary practice location
1228 Harden St
Columbia, SC 29204-1800
Mailing address
PO Box 3788
Columbia, SC 29230-3788
Phone (803) 733-5969
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LL33831 | SC | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309478400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398384000000",
"number": "1740577469",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3788",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292303788",
"telephone_number": "803-733-5969",
"fax_number": "803-217-0026"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1228 HARDEN ST",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292041800",
"telephone_number": "803-748-7002",
"fax_number": "803-252-5259"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONZALEZ",
"first_name": "TESSA",
"middle_name": "VERA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-07-01",
"last_updated": "2014-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "SC",
"license": "LL33831",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.