MEDICARE: YANIRA GONZALEZ GREGORES

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	RBT-25-423717

General Provider Information

NPI Number	:	1134922883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YANIRA GONZALEZ GREGORES

Provider Business Mailing Address
First Line	:	2607 AUBURN AVE W # 33614
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-2847
Country	:	US
Telephone Number	:	727-601-8394
Fax Number	:

Provider Business Practice Location Address
First Line	:	2607 AUBURN AVE W # 33614
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-2847
Country	:	US
Telephone Number	:	727-601-8394
Fax Number	:

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

Provider Enumeration Date	:	03/28/2025
Last Update Date	:	03/28/2025

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