MEDICARE: MR. YUCSEL GONGORA LEYVA

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	343900000X	Non-emergency Medical Transport (VAN)	7205936	FL

General Provider Information

NPI Number	:	1386120327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. YUCSEL GONGORA LEYVA

Provider Business Mailing Address
First Line	:	1853 FLORIDA MANGO RD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-6736
Country	:	US
Telephone Number	:	561-510-0911
Fax Number	:

Provider Business Practice Location Address
First Line	:	1853 FLORIDA MANGO RD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-6736
Country	:	US
Telephone Number	:	561-510-0911
Fax Number	:

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

Provider Enumeration Date	:	07/12/2018
Last Update Date	:	07/12/2018

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