MEDICARE: YAZMIN ESTREMERA M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	4109	PR

General Provider Information

NPI Number	:	1437593886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAZMIN ESTREMERA M.A.

Provider Business Mailing Address
First Line	:	130 AVE WINSTON CHURCHILL
Second Line	:	PMB 240
City	:	SAN JUAN
State	:	PR
Zip	:	00926-6065
Country	:	US
Telephone Number	:	787-645-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 AVE WINSTON CHURCHILL
Second Line	:	PMB 240
City	:	SAN JUAN
State	:	PR
Zip	:	00926-6065
Country	:	US
Telephone Number	:	787-645-2020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2013
Last Update Date	:	04/28/2013

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