Healthcare Provider Details

I. General information

NPI: 1548953037
Provider Name (Legal Business Name): YANINA I MARTINEZ TERRERO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE JOSE MENDEZ CARDONA #3
SAN SEBASTIAN PR
00685
US

IV. Provider business mailing address

HC 5 BOX 103353
MOCA PR
00676-9721
US

V. Phone/Fax

Practice location:
  • Phone: 787-896-1850
  • Fax: 787-280-9497
Mailing address:
  • Phone: 939-258-2379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1647
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: