MEDICARE: YANIRA ANGLADA PSY D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	2715	PR

General Provider Information

NPI Number	:	1073723649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YANIRA ANGLADA PSY D

Provider Business Mailing Address
First Line	:	CALLE 9 G-38
Second Line	:	ALTURAS DEL ENCANTO
City	:	JUANA DIAZ
State	:	PR
Zip	:	00795
Country	:	US
Telephone Number	:	787-837-2538
Fax Number	:

Provider Business Practice Location Address
First Line	:	EDIF. SAN GERALDO SUITE 207G
Second Line	:	BO. TIERRA SANTA CARR.149
City	:	VILLALBA
State	:	PR
Zip	:	00766
Country	:	US
Telephone Number	:	787-837-2538
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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