Provider Demographics
NPI:1619793296
Name:GONZALEZ PARDO VEGA, YURISLEIDY (106S00000X)
Entity type:Individual
Prefix:
First Name:YURISLEIDY
Middle Name:
Last Name:GONZALEZ PARDO VEGA
Suffix:
Gender:F
Credentials:106S00000X
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 DESOTO BLVD N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34120-8949
Mailing Address - Country:US
Mailing Address - Phone:239-316-2938
Mailing Address - Fax:
Practice Address - Street 1:2640 DESOTO BLVD N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34120-8949
Practice Address - Country:US
Practice Address - Phone:239-316-2938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-27
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-363551106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician