MEDICARE: YELAMY TRAVIESO 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	106S00000X	Behavior Technician	BACB1369468	FL

General Provider Information

NPI Number	:	1902760929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YELAMY TRAVIESO GONZALEZ

Provider Business Mailing Address
First Line	:	6913 BARRY RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-2915
Country	:	US
Telephone Number	:	813-506-3269
Fax Number	:

Provider Business Practice Location Address
First Line	:	6913 BARRY RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-2915
Country	:	US
Telephone Number	:	813-506-3269
Fax Number	:

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

Provider Enumeration Date	:	12/13/2025
Last Update Date	:	12/13/2025

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