Provider Demographics
NPI:1164891057
Name:RODRIGUEZ MARTINEZ, YARIS MARIA
Entity Type:Individual
Prefix:
First Name:YARIS
Middle Name:MARIA
Last Name:RODRIGUEZ MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PUEBLO NUEVO D28
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698
Mailing Address - Country:US
Mailing Address - Phone:787-242-3549
Mailing Address - Fax:787-263-2512
Practice Address - Street 1:PUEBLO NUEVO D28
Practice Address - Street 2:
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698
Practice Address - Country:US
Practice Address - Phone:787-242-3549
Practice Address - Fax:787-263-2512
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR224171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical