Provider Demographics
NPI:1891449922
Name:GONZALEZ ROSICH, YASHIRA MARIE
Entity Type:Individual
Prefix:
First Name:YASHIRA
Middle Name:MARIE
Last Name:GONZALEZ ROSICH
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 1:444 PATRICIA ALFORD DR
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-6758
Mailing Address - Country:US
Mailing Address - Phone:787-216-7996
Mailing Address - Fax:
Practice Address - Street 1:1307 E OSCEOLA PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-1605
Practice Address - Country:US
Practice Address - Phone:844-665-4827
Practice Address - Fax:855-852-1974
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23170208D00000X
FLACN1557208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice