Provider Demographics
NPI:1033633698
Name:GONZALEZ, YODALYS
Entity type:Individual
Prefix:
First Name:YODALYS
Middle Name:
Last Name:GONZALEZ
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 1:4221 NE 22ND PL FL 33909
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-3041
Mailing Address - Country:US
Mailing Address - Phone:305-303-7576
Mailing Address - Fax:
Practice Address - Street 1:4221 NE 22ND PL FL 33909
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-3041
Practice Address - Country:US
Practice Address - Phone:786-206-6500
Practice Address - Fax:786-206-4702
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-20-44788103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst