Provider Demographics
NPI:1366808867
Name:GOMEZ, YAMILE
Entity type:Individual
Prefix:
First Name:YAMILE
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7855 NW 12TH ST STE 117
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1826
Mailing Address - Country:US
Mailing Address - Phone:305-742-2189
Mailing Address - Fax:305-742-2190
Practice Address - Street 1:7855 NW 12TH ST STE 117
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1826
Practice Address - Country:US
Practice Address - Phone:305-742-2189
Practice Address - Fax:305-742-2190
Is Sole Proprietor?:No
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-15-9474-28407103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst