MEDICARE: YGONGORANP LLC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1275392805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YGONGORANP LLC

Provider Business Mailing Address
First Line	:	6405 NW 36TH ST STE 213
Second Line	:
City	:	VIRGINIA GARDENS
State	:	FL
Zip	:	33166-6973
Country	:	US
Telephone Number	:	786-562-7479
Fax Number	:	305-564-7610

Provider Business Practice Location Address
First Line	:	6405 NW 36TH ST STE 213
Second Line	:
City	:	VIRGINIA GARDENS
State	:	FL
Zip	:	33166-6973
Country	:	US
Telephone Number	:	786-562-7479
Fax Number	:	305-564-7610

Authorized Official
Title or Position	:	MANAGER
Name	:	YOVANY GONGORA
Credential	:	APRN
Telephone Number	:	786-660-1844

Provider Enumeration Date	:	03/18/2024
Last Update Date	:	06/11/2026

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Directions to “YGONGORANP LLC ” Practice Location

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