Healthcare Provider Details

I. General information

NPI: 1457564320
Provider Name (Legal Business Name): YOLANDA OCASIO MARIN ADMINISTRATOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WIPS THERAPEUTIC GROUP #70 RELAMPAGO ST. SUITE 101
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

URB.RAMIREZ #45 SAN JOSE ST.
CABO ROJO PR
00623
US

V. Phone/Fax

Practice location:
  • Phone: 787-833-2899
  • Fax: 787-833-2899
Mailing address:
  • Phone: 787-851-0767
  • Fax: 787-851-0767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: