Provider Demographics
NPI:1114562915
Name:GONZALEZ REINOSO, YUTSIMI
Entity Type:Individual
Prefix:
First Name:YUTSIMI
Middle Name:
Last Name:GONZALEZ REINOSO
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 1:6175 NW 186TH ST APT 204
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-6083
Mailing Address - Country:US
Mailing Address - Phone:786-454-5971
Mailing Address - Fax:
Practice Address - Street 1:6175 NW 186TH ST APT 204
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-6083
Practice Address - Country:US
Practice Address - Phone:786-454-5971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-104292106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBACB530598Medicaid