Healthcare Provider Details

I. General information

NPI: 1649168725
Provider Name (Legal Business Name): YARELIS ACOSTA ORTIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 358
CROWNPOINT NM
87313-0358
US

IV. Provider business mailing address

PO BOX 358
CROWNPOINT NM
87313-0358
US

V. Phone/Fax

Practice location:
  • Phone: 505-786-5291
  • Fax:
Mailing address:
  • Phone: 505-786-5291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN9416832
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: