MEDICARE: YENISET A GOMEZ GUERRA

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	21-156699	FL

General Provider Information

NPI Number	:	1235711615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YENISET A GOMEZ GUERRA

Provider Business Mailing Address
First Line	:	4556 JILL PL
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-4449
Country	:	US
Telephone Number	:	702-461-1448
Fax Number	:

Provider Business Practice Location Address
First Line	:	4556 JILL PL
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-4449
Country	:	US
Telephone Number	:	702-461-1448
Fax Number	:

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

Provider Enumeration Date	:	04/25/2021
Last Update Date	:	04/25/2021

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Directions to “ YENISET A GOMEZ GUERRA ” Practice Location

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