Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3100 | PR |
Y | 103T00000X | Psychologist | 3100 | PR |
NPI | 1003134925 |
---|---|
Provider Name | Yania Ivelisse Enriquez |
First Address | Guayama, PR 00784-4967 |
Second Address | Guayama, PR 00784-4967 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2010 |
Last Update Date | 17/05/2010 |