MEDICARE: YAZMIN GONCE

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	225700000X	Massage Therapist	MA48241	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MA 48241	OTHER	FL	MASSAGE THERAPY

General Provider Information

NPI Number	:	1932374550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAZMIN GONCE

Provider Business Mailing Address
First Line	:	8 LINDSEY CT
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-5222
Country	:	US
Telephone Number	:	305-805-0845
Fax Number	:	305-805-4405

Provider Business Practice Location Address
First Line	:	8 LINDSEY CT
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-5222
Country	:	US
Telephone Number	:	305-805-0845
Fax Number	:	305-805-4405

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

Provider Enumeration Date	:	04/24/2008
Last Update Date	:	04/24/2008

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Directions to “ YAZMIN GONCE ” Practice Location

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