Healthcare Provider Details

I. General information

NPI: 1306454681
Provider Name (Legal Business Name): YANOEL LAZARO GONZALEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1696 S MILITARY TRL STE C
WEST PALM BEACH FL
33415-5625
US

IV. Provider business mailing address

4284 S LANDAR DR
LAKE WORTH FL
33463-8915
US

V. Phone/Fax

Practice location:
  • Phone: 786-731-5194
  • Fax:
Mailing address:
  • Phone: 786-731-5194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-24-15135
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: