Provider Demographics
NPI:1477089712
Name:GONZALEZ MOJENA, YOANLI
Entity Type:Individual
Prefix:
First Name:YOANLI
Middle Name:
Last Name:GONZALEZ MOJENA
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 1:19672 NW 59TH PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4844
Mailing Address - Country:US
Mailing Address - Phone:772-446-4621
Mailing Address - Fax:954-272-7968
Practice Address - Street 1:19672 NW 59TH PL
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-4844
Practice Address - Country:US
Practice Address - Phone:772-446-4621
Practice Address - Fax:954-272-7968
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-05
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician