Provider Demographics
NPI:1104228550
Name:GONZALEZ-HUERTAS, YANIA
Entity type:Individual
Prefix:
First Name:YANIA
Middle Name:
Last Name:GONZALEZ-HUERTAS
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:CARR 803 KM 5.9
Mailing Address - Street 2:BO PALOS BLANCOS
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783
Mailing Address - Country:US
Mailing Address - Phone:787-605-8260
Mailing Address - Fax:
Practice Address - Street 1:CARR 803 KM. 5.9
Practice Address - Street 2:BO PALOS BLANCOS
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783
Practice Address - Country:US
Practice Address - Phone:787-605-8260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4090865343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)