Provider Demographics
NPI:1114103579
Name:YEPES, GLORIA R II (SA12791)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:R
Last Name:YEPES
Suffix:II
Gender:F
Credentials:SA12791
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 NW 77TH AVE STE 28
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2522
Mailing Address - Country:US
Mailing Address - Phone:954-793-0775
Mailing Address - Fax:786-391-2963
Practice Address - Street 1:9500 NW 77TH AVE STE 28
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-2522
Practice Address - Country:US
Practice Address - Phone:954-793-0775
Practice Address - Fax:786-221-4420
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2014-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 12791235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist