Healthcare Provider Details

I. General information

NPI: 1346144912
Provider Name (Legal Business Name): YUONMARIE FELICIANO TIRADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 CALLE KARLA MICHELLE
SAN JUAN PR
00915-2430
US

IV. Provider business mailing address

272 CALLE KARLA MICHELLE
SAN JUAN PR
00915-2430
US

V. Phone/Fax

Practice location:
  • Phone: 787-328-9411
  • Fax:
Mailing address:
  • Phone: 787-328-9411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8396
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: