Healthcare Provider Details

I. General information

NPI: 1124806419
Provider Name (Legal Business Name): YELIANNE MARI AFANADOR GONZALEZ MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SUITE 201 MOCA PROFESSIONAL PLAZA
MOCA PR
00676-9998
US

IV. Provider business mailing address

PARC. LOMAS VERDES CALLE OPALO 227
MOCA PR
00676
US

V. Phone/Fax

Practice location:
  • Phone: 939-418-3364
  • Fax:
Mailing address:
  • Phone: 939-418-3364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number7110
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: