Healthcare Provider Details

I. General information

NPI: 1013757038
Provider Name (Legal Business Name): YAFREISIS LLANOS RUIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 BLACKBURN CTR
GLOUCESTER MA
01930-2268
US

IV. Provider business mailing address

110 BOSTON ST
SALEM MA
01970-1402
US

V. Phone/Fax

Practice location:
  • Phone: 781-592-5691
  • Fax:
Mailing address:
  • Phone: 781-592-5691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: