Provider Demographics
NPI:1386217669
Name:GONZALEZ, YELENA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:YELENA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 78 BOX 1636
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96326-0017
Mailing Address - Country:US
Mailing Address - Phone:786-334-4153
Mailing Address - Fax:
Practice Address - Street 1:YOKOTA AIR BASE, JAPAN
Practice Address - Street 2:374TH MEDICAL GROUP, YOKOTA AIR BASE HOSPITAL
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96326-0017
Practice Address - Country:US
Practice Address - Phone:786-334-4153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10897103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPY10897OtherFLORIDA DEPARTMENT OF HEALTH