Provider Demographics
NPI:1922049873
Name:YANEZ, GONZALO FLAVIO (MD)
Entity Type:Individual
Prefix:MR
First Name:GONZALO
Middle Name:FLAVIO
Last Name:YANEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7765 SW 87TH AVE
Mailing Address - Street 2:SUITE #120
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2596
Mailing Address - Country:US
Mailing Address - Phone:305-279-7001
Mailing Address - Fax:305-279-7067
Practice Address - Street 1:7765 SW 87TH AVE
Practice Address - Street 2:SUITE #120
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2596
Practice Address - Country:US
Practice Address - Phone:305-279-7001
Practice Address - Fax:305-279-7067
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0030470174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD78873Medicare UPIN
FL95009Medicare ID - Type Unspecified