MEDICARE: YENIS GONZALEZ MA

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	225700000X	Massage Therapist	MA 65587	FL

General Provider Information

NPI Number	:	1790022069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YENIS GONZALEZ MA

Provider Business Mailing Address
First Line	:	8700 W FLAGLER ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33174-2401
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8700 W FLAGLER ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33174-2401
Country	:	US
Telephone Number	:	305-221-0515
Fax Number	:	305-221-0513

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

Provider Enumeration Date	:	01/07/2013
Last Update Date	:	01/07/2013

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Directions to “ YENIS GONZALEZ MA” Practice Location

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