Healthcare Provider Details

I. General information

NPI: 1750212247
Provider Name (Legal Business Name): YAJAIRA PEREZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2402 CALLE PRADO VALLE ALTO
PONCE PR
00730
US

IV. Provider business mailing address

2402 CALLE PRADO VALLE ALTO
PONCE PR
00730
US

V. Phone/Fax

Practice location:
  • Phone: 787-415-4973
  • Fax: 787-415-4973
Mailing address:
  • Phone: 787-415-4973
  • Fax: 787-415-4973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6871
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: