Provider Demographics
NPI:1518079474
Name:GONZALEZ, YESENIA (MS)
Entity Type:Individual
Prefix:MISS
First Name:YESENIA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 3 BOX 12930
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-9607
Mailing Address - Country:US
Mailing Address - Phone:787-762-3737
Mailing Address - Fax:
Practice Address - Street 1:AVE ROBERTO CLEMENTE 2716
Practice Address - Street 2:URB VILLA CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-762-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR586231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9820025OtherHUMANA INSURANCE (PPO)
PR250086OtherPREFERRED HEALTH