Healthcare Provider Details

I. General information

NPI: 1962013441
Provider Name (Legal Business Name): YEILEEN CONCEPCION HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 AVE UNIV INTERAMERICANA
SAN GERMAN PR
00683-4455
US

IV. Provider business mailing address

HC 59 BOX 5982
AGUADA PR
00602-9637
US

V. Phone/Fax

Practice location:
  • Phone: 787-629-4671
  • Fax:
Mailing address:
  • Phone: 787-321-6661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6474
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: