Healthcare Provider Details

I. General information

NPI: 1205760790
Provider Name (Legal Business Name): MR. MYRNA ELISA SEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

A3 CALLE BRISAS DEL MAR
YAUCO PR
00698-4569
US

IV. Provider business mailing address

A3 CALLE BRISAS DEL MAR
YAUCO PR
00698-4569
US

V. Phone/Fax

Practice location:
  • Phone: 787-361-2022
  • Fax:
Mailing address:
  • Phone: 787-361-2022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15287
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: