Healthcare Provider Details

I. General information

NPI: 1497632400
Provider Name (Legal Business Name): YASIRIS CORAL IGLESIAS BD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#500 PLAZA CHEVRES, STE 4 URB. ALTURAS DE FLAMBOYAN AVE. TINTE. NELSON MARTINEZ
BAYAMON PR
00959
US

IV. Provider business mailing address

675 CALLE CUEVAS BUSTAMANTE BOX 116
SAN JUAN PR
00918
US

V. Phone/Fax

Practice location:
  • Phone: 787-501-4427
  • Fax:
Mailing address:
  • Phone: 787-501-4427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number007599
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: