Healthcare Provider Details

I. General information

NPI: 1780516120
Provider Name (Legal Business Name): YARELIS VAZQUEZ HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 AVE SAN CRISTOBAL
COTO LAUREL PR
00780-2896
US

IV. Provider business mailing address

URB HACIENDA CONCORDIA 11175 CALLE MIOSOTI
SANTA ISABEL PR
00757
US

V. Phone/Fax

Practice location:
  • Phone: 939-835-7173
  • Fax:
Mailing address:
  • Phone: 939-222-7688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4808
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: