MEDICARE: YIVVY GONZALEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	G235-162-85-000-0	FL
2	106S00000X	Behavior Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164935870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YIVVY GONZALEZ

Provider Business Mailing Address
First Line	:	2985 BOSQUE AVE APT 102
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34746-4421
Country	:	US
Telephone Number	:	347-819-9157
Fax Number	:

Provider Business Practice Location Address
First Line	:	2985 BOSQUE AVE APT 102
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34746-4421
Country	:	US
Telephone Number	:	347-819-9157
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2017
Last Update Date	:	06/01/2026

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Directions to “ YIVVY GONZALEZ ” Practice Location

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