Healthcare Provider Details

I. General information

NPI: 1538774427
Provider Name (Legal Business Name): YOMAYRA CRUZ HERNANDEZ I PSY D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

THE RENAL CENTER OF MANATI CARR. 2 KM. 47.7
MANATI PR
00674
US

IV. Provider business mailing address

URBANIZACION LOS CAOBOS CALLE GUARAGUAO 1729
PONCE PR
00716
US

V. Phone/Fax

Practice location:
  • Phone: 787-854-3322
  • Fax:
Mailing address:
  • Phone: 787-372-1462
  • Fax: 787-848-6334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7335
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier7335
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerPSICOLIGIA CLINICA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: