Healthcare Provider Details

I. General information

NPI: 1164031993
Provider Name (Legal Business Name): YARALYZ SERRANO AYALA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 361 KM 6.9
SAN GERMAN PR
00683
US

IV. Provider business mailing address

PO BOX 5000-233
SAN GERMAN PR
00683
US

V. Phone/Fax

Practice location:
  • Phone: 787-383-8343
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14422
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: