Provider Demographics
NPI:1578038261
Name:GOMEZ VILLIVA, YASNAY (MD)
Entity type:Individual
Prefix:
First Name:YASNAY
Middle Name:
Last Name:GOMEZ VILLIVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4814 SW 145TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-5006
Mailing Address - Country:US
Mailing Address - Phone:786-532-7043
Mailing Address - Fax:
Practice Address - Street 1:6501 NW 36TH ST STE 411
Practice Address - Street 2:
Practice Address - City:VIRGINIA GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33166-6964
Practice Address - Country:US
Practice Address - Phone:786-522-7203
Practice Address - Fax:786-522-7204
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN1757208D00000X
171M00000X
PR24695208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty