Healthcare Provider Details

I. General information

NPI: 1730044827
Provider Name (Legal Business Name): YALENA TERRERO MARTINEZ
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

552 HARVARD ST
MATTAPAN MA
02126-1533
US

IV. Provider business mailing address

552 HARVARD ST
MATTAPAN MA
02126-1533
US

V. Phone/Fax

Practice location:
  • Phone: 617-898-8919
  • Fax:
Mailing address:
  • Phone: 617-898-8919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number104006215
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number2025045594
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: