Provider Demographics
NPI:1063024966
Name:GONZALEZ PAREDES, YAILIN
Entity Type:Individual
Prefix:
First Name:YAILIN
Middle Name:
Last Name:GONZALEZ PAREDES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28130 PINE HAVEN WAY APT 21
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-6872
Mailing Address - Country:US
Mailing Address - Phone:786-449-0709
Mailing Address - Fax:
Practice Address - Street 1:28130 PINE HAVEN WAY APT 21
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-6872
Practice Address - Country:US
Practice Address - Phone:786-449-0709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician