Provider Demographics
NPI:1225654890
Name:PEREZ, YARITZA DYNEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:YARITZA
Middle Name:DYNEL
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:YUNQUESITO STREET MANSIONES DE CAROLINA
Mailing Address - Street 2:FF-1
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-0000
Mailing Address - Country:US
Mailing Address - Phone:787-463-3137
Mailing Address - Fax:
Practice Address - Street 1:YUNQUESITO STREET MANSIONES DE CAROLINA
Practice Address - Street 2:FF-1
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-0000
Practice Address - Country:US
Practice Address - Phone:787-463-3137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3924103TC1900X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRNONEOtherNONE