Healthcare Provider Details

I. General information

NPI: 1518722248
Provider Name (Legal Business Name): YAJAIRA TORRES OQUENDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CALLE OLIVO
LAS PIEDRAS PR
00771-4500
US

IV. Provider business mailing address

5 CALLE OLIVO
LAS PIEDRAS PR
00771-4500
US

V. Phone/Fax

Practice location:
  • Phone: 939-278-4940
  • Fax:
Mailing address:
  • Phone: 939-278-4940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14851
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: