MEDICARE: YORLENI MAYORGA

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	246Z00000X	Other Specialist/Technologist		PA
2	246ZA2600X	Medical Art Specialist/Technologist		PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	246Z00000X	OTHER	PA	OTHER

General Provider Information

NPI Number	:	1467127134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YORLENI MAYORGA

Provider Business Mailing Address
First Line	:	25 E REDMAN AVE
Second Line	:
City	:	HADDONFIELD
State	:	NJ
Zip	:	08033-2314
Country	:	US
Telephone Number	:	856-433-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 E REDMAN AVE
Second Line	:
City	:	HADDONFIELD
State	:	NJ
Zip	:	08033-2314
Country	:	US
Telephone Number	:	856-433-2100
Fax Number	:

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

Provider Enumeration Date	:	08/13/2021
Last Update Date	:	08/13/2021

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Directions to “ YORLENI MAYORGA ” Practice Location

Language	Start Address	Practice Location

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