Provider Demographics
NPI:1053968826
Name:GONZALEZ, YOLANGILICIA (CERTIFIED PHLEBOTOMY)
Entity type:Individual
Prefix:MS
First Name:YOLANGILICIA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:CERTIFIED PHLEBOTOMY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 BRECKINRIDGE BLVD APT 525
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-7637
Mailing Address - Country:US
Mailing Address - Phone:256-571-5762
Mailing Address - Fax:
Practice Address - Street 1:3450 BRECKINRIDGE BLVD APT 525
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-7637
Practice Address - Country:US
Practice Address - Phone:256-571-5762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA889104246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy