MEDICARE: MISS YAZMIN GONZALEZ M.S. CCC-SLP

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	235Z00000X	Speech-Language Pathologist	SA16064	FL

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	:	1417402959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS YAZMIN GONZALEZ M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	4251 SW 141ST AVE
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-3041
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 W 49TH ST STE 332
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3489
Country	:	US
Telephone Number	:	786-789-5305
Fax Number	:	786-789-5315

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

Provider Enumeration Date	:	08/24/2016
Last Update Date	:	05/06/2020

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Directions to “ MISS YAZMIN GONZALEZ M.S. CCC-SLP” Practice Location

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