Healthcare Provider Details

I. General information

NPI: 1225902034
Provider Name (Legal Business Name): ITZA YIRELLE LLAURADOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2025
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 CALLE LUIS CASTELLON
MAYAGUEZ PR
00680-1902
US

IV. Provider business mailing address

253 CALLE LUIS CASTELLON
MAYAGUEZ PR
00680-1902
US

V. Phone/Fax

Practice location:
  • Phone: 787-675-9244
  • Fax:
Mailing address:
  • Phone: 787-675-9244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1458
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: