Healthcare Provider Details

I. General information

NPI: 1790608156
Provider Name (Legal Business Name): EVOLVE MENTAL HEALTH CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 2 KM 86.2 MARGINAL BO CARRIZALES
HATILLO PR
00659-7358
US

IV. Provider business mailing address

HC 1 BOX 8019
HATILLO PR
00659-7358
US

V. Phone/Fax

Practice location:
  • Phone: 939-272-6658
  • Fax:
Mailing address:
  • Phone: 939-272-6658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YAMARIS VAZQUEZ
Title or Position: PRESIDENT
Credential: PSYD
Phone: 939-272-6658