Provider Demographics
NPI:1629574330
Name:FENOLLAL GONZALEZ, CARMEN YADIRA
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:YADIRA
Last Name:FENOLLAL GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CARMEN
Other - Middle Name:YADIRA
Other - Last Name:FENOLLAL GONZALEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9050 NW 28TH ST APT 120
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5213
Mailing Address - Country:US
Mailing Address - Phone:787-398-7614
Mailing Address - Fax:
Practice Address - Street 1:9050 NW 28TH ST APT 120
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5213
Practice Address - Country:US
Practice Address - Phone:130-576-7810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker