Healthcare Provider Details

I. General information

NPI: 1083538193
Provider Name (Legal Business Name): YARITZA MARIE PAGAN PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENIDA LAUREL, NUMERO 2A2, BAYAMON, 00956
BAYAMON PR
00956
US

IV. Provider business mailing address

2A2 AVENIDA LUAREL BAYAMON PUERTO RICO 00956
BAYAMON PR
00956
US

V. Phone/Fax

Practice location:
  • Phone: 787-400-6000
  • Fax:
Mailing address:
  • Phone: 787-400-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number6877863
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: