Healthcare Provider Details

I. General information

NPI: 1164229464
Provider Name (Legal Business Name): YMARYNOSKY D PINERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HF16 CALLE LIZZIE GRAHAM
TOA BAJA PR
00949-3634
US

IV. Provider business mailing address

PO BOX 50757
TOA BAJA PR
00950-0757
US

V. Phone/Fax

Practice location:
  • Phone: 787-795-2935
  • Fax:
Mailing address:
  • Phone: 939-363-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number2496-P.A.
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: