Provider Demographics
NPI:1881442150
Name:MARIN GONZALEZ, YANDY
Entity type:Individual
Prefix:
First Name:YANDY
Middle Name:
Last Name:MARIN GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 NW 114TH AVE APT 2201
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-4800
Mailing Address - Country:US
Mailing Address - Phone:305-399-2568
Mailing Address - Fax:
Practice Address - Street 1:4500 NW 114TH AVE APT 2201
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4800
Practice Address - Country:US
Practice Address - Phone:305-399-2568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-338931106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician