Provider Demographics
NPI:1619698883
Name:GONZALEZ, YOLANDA YANIN
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:YANIN
Last Name:GONZALEZ
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 1:3809 71ST TER E
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-5166
Mailing Address - Country:US
Mailing Address - Phone:972-880-0106
Mailing Address - Fax:
Practice Address - Street 1:3809 71ST TER E
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-5166
Practice Address - Country:US
Practice Address - Phone:972-880-0106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician