Active NPI
Yadisleidys Gongora
- Behavior Technician
- Lehigh Acres, FL
National Provider Identifier
1932819844
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-20-147781
- Practice address
- 3616 8TH St SW
Lehigh Acres, FL 33976-2419 - Phone
- (239) 294-0901
- NPI assigned
- Dec 1, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-20-147781 | FL | Primary |
Addresses
Primary practice location
3616 8TH St SW
Lehigh Acres, FL 33976-2419
Mailing address
3616 8TH St SW
Lehigh Acres, FL 33976-2419
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 109947600 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-20-147781 | FL | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1669852800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1669852800000",
"number": "1932819844",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3616 8TH ST SW",
"city": "LEHIGH ACRES",
"state": "FL",
"postal_code": "339762419"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3616 8TH ST SW",
"city": "LEHIGH ACRES",
"state": "FL",
"postal_code": "339762419",
"telephone_number": "239-294-0901"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONGORA",
"first_name": "YADISLEIDYS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-12-01",
"last_updated": "2022-12-01",
"certification_date": "2022-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "FL",
"license": "RBT-20-147781",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "109947600",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lehigh Acres, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.