Healthcare Provider Details

I. General information

NPI: 1508183005
Provider Name (Legal Business Name): YAUCO HEALTHCARE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 04/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 128 KM. 1.0
YAUCO PR
00698
US

IV. Provider business mailing address

PO BOX 5643
YAUCO PR
00698-5643
US

V. Phone/Fax

Practice location:
  • Phone: 787-856-1000
  • Fax: 787-856-4250
Mailing address:
  • Phone: 787-856-1000
  • Fax: 787-856-4250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberCASC-0462
License Number StatePR

VIII. Authorized Official

Name: PEDRO F BAREZ
Title or Position: CEO
Credential: MHSA FACHE
Phone: 787-856-1000