Healthcare Provider Details

I. General information

NPI: 1265294094
Provider Name (Legal Business Name): YARIELIS RIVERA CAMACHO MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2024
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 806 KM 0.8 QUEBRADA ARENAS
TOA ALTA PR
00953-9662
US

IV. Provider business mailing address

RR 2 BOX 6036
TOA ALTA PR
00953-9662
US

V. Phone/Fax

Practice location:
  • Phone: 787-628-7982
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number7850
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: