MEDICARE: YOANDRA M GOMEZ UNCU

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

General Provider Information

NPI Number	:	1023761699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOANDRA M GOMEZ UNCU

Provider Business Mailing Address
First Line	:	6660 ESTERO BLVD # B404
Second Line	:
City	:	FORT MYERS BEACH
State	:	FL
Zip	:	33931-4567
Country	:	US
Telephone Number	:	303-799-6969
Fax Number	:

Provider Business Practice Location Address
First Line	:	6660 ESTERO BLVD # B404
Second Line	:
City	:	FORT MYERS BEACH
State	:	FL
Zip	:	33931-4567
Country	:	US
Telephone Number	:	303-799-6969
Fax Number	:

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

Provider Enumeration Date	:	02/02/2022
Last Update Date	:	02/02/2022

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