MEDICARE: YUSIMID GONZALEZ MELCHOR

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	163W00000X	Registered Nurse	710522	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265998660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YUSIMID GONZALEZ MELCHOR

Provider Business Mailing Address
First Line	:	10300 SW 72ND ST STE 261C
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-3014
Country	:	US
Telephone Number	:	786-367-8559
Fax Number	:

Provider Business Practice Location Address
First Line	:	10300 SW 72ND ST STE 261C
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-3014
Country	:	US
Telephone Number	:	786-367-8559
Fax Number	:

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

Provider Enumeration Date	:	02/11/2019
Last Update Date	:	02/11/2019

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