Healthcare Provider Details

I. General information

NPI: 1598191793
Provider Name (Legal Business Name): YSL PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE PONCE DE LEON PARADA 37 1/2 SUITE 608 TORRE DE AUXILIO MUTUO
SAN JUAN PR
00917
US

IV. Provider business mailing address

30 CALLE TURQUESA SENDEROS EN MONTEHIEDRA
SAN JUAN PR
00926-7064
US

V. Phone/Fax

Practice location:
  • Phone: 787-777-8181
  • Fax: 787-777-8180
Mailing address:
  • Phone: 787-636-8272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number12903
License Number StatePR

VIII. Authorized Official

Name: CARMEN A MENDEZ MOLINA
Title or Position: PRESIDENT
Credential: MD
Phone: 787-777-8181