Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 9352092 | FL |
NPI | 1003341892 |
---|---|
Provider Name | Yanet Bou Gomez |
First Address | Miami, FL 33135-1249 |
Second Address | Miami, FL 33135-1249 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2017 |
Last Update Date | 29/04/2017 |