Healthcare Provider Details

I. General information

NPI: 1134055700
Provider Name (Legal Business Name): YESENIA HUERTAS GARCIA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 CARR 19 APT G204
GUAYNABO PR
00966-4158
US

IV. Provider business mailing address

1500 CARR 19 APT G204
GUAYNABO PR
00966-4158
US

V. Phone/Fax

Practice location:
  • Phone: 787-510-2562
  • Fax:
Mailing address:
  • Phone: 787-510-2562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6223
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: