Provider Demographics
NPI:1952351066
Name:GOZZO, YVETTE (MD)
Entity Type:Individual
Prefix:MRS
First Name:YVETTE
Middle Name:
Last Name:GOZZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:YVETTE
Other - Middle Name:
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:320 SUPERIOR AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-2741
Mailing Address - Country:US
Mailing Address - Phone:949-642-6200
Mailing Address - Fax:
Practice Address - Street 1:320 SUPERIOR AVE STE 200
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-2741
Practice Address - Country:US
Practice Address - Phone:949-642-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA74996207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB251683Medicare Oscar/Certification
NJ0074837Medicaid
NJI37856Medicare UPIN