Provider Demographics
NPI:1932628203
Name:GONZALEZ HERNANDEZ, YAMILA
Entity Type:Individual
Prefix:
First Name:YAMILA
Middle Name:
Last Name:GONZALEZ HERNANDEZ
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 1:14964 NW 89TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33018-1336
Mailing Address - Country:US
Mailing Address - Phone:305-619-3202
Mailing Address - Fax:305-463-6693
Practice Address - Street 1:717 PONCE DE LEON BLVD STE 717
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2060
Practice Address - Country:US
Practice Address - Phone:305-619-3202
Practice Address - Fax:305-463-6693
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty