Healthcare Provider Details

I. General information

NPI: 1740443456
Provider Name (Legal Business Name): YANELLY ROSA PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 2 KM 123.7 BARR CAIMITAL ALTO
AGUADILLA PR
00603-6501
US

IV. Provider business mailing address

PO BOX 3695
AGUADILLA PR
00605-3695
US

V. Phone/Fax

Practice location:
  • Phone: 787-658-0260
  • Fax: 787-658-0260
Mailing address:
  • Phone: 787-658-0260
  • Fax: 787-658-0260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number5999
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: