Provider Demographics
NPI:1598148652
Name:GONZALEZ ESTOPINAN, YUDITH
Entity Type:Individual
Prefix:
First Name:YUDITH
Middle Name:
Last Name:GONZALEZ ESTOPINAN
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 1:3675 W 11TH AVE APT 315
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4963
Mailing Address - Country:US
Mailing Address - Phone:786-879-5225
Mailing Address - Fax:
Practice Address - Street 1:3675 W 11TH AVE APT 315
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4963
Practice Address - Country:US
Practice Address - Phone:786-879-5225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 214161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice