Provider Demographics
NPI:1366218604
Name:ALONSO GONZALEZ, YENDRIS
Entity type:Individual
Prefix:
First Name:YENDRIS
Middle Name:
Last Name:ALONSO GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11213 SW 33RD CIRCLE PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3435
Mailing Address - Country:US
Mailing Address - Phone:813-965-3566
Mailing Address - Fax:
Practice Address - Street 1:11213 SW 33RD CIRCLE PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3435
Practice Address - Country:US
Practice Address - Phone:813-965-3566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11029893363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty