Healthcare Provider Details

I. General information

NPI: 1215385273
Provider Name (Legal Business Name): DR. YAZMIN CANCEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

Y2 CALLE 12
BAYAMON PR
00959-8036
US

IV. Provider business mailing address

Y2 CALLE 12
BAYAMON PR
00959-8036
US

V. Phone/Fax

Practice location:
  • Phone: 787-376-1886
  • Fax:
Mailing address:
  • Phone: 787-376-1886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number1889
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1889
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number1889
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: