Provider Demographics
NPI:1093209983
Name:GONEZ, YAHAIRA
Entity Type:Individual
Prefix:
First Name:YAHAIRA
Middle Name:
Last Name:GONEZ
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 1:118 SPOONBILL CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-5108
Mailing Address - Country:US
Mailing Address - Phone:407-923-2957
Mailing Address - Fax:
Practice Address - Street 1:118 SPOONBILL CT
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-5108
Practice Address - Country:US
Practice Address - Phone:407-923-2957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management