Provider Demographics
NPI:1235700360
Name:MARTELL, YIDATH ANNETTE
Entity Type:Individual
Prefix:DR
First Name:YIDATH
Middle Name:ANNETTE
Last Name:MARTELL
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:VALLE VERDE, CALLE RIO PORTUGUES
Mailing Address - Street 2:AQ61
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-3205
Mailing Address - Country:US
Mailing Address - Phone:939-644-7045
Mailing Address - Fax:
Practice Address - Street 1:VALLE VERDE, CALLE RIO PORTUGUES
Practice Address - Street 2:AQ61
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-3205
Practice Address - Country:US
Practice Address - Phone:939-644-7045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2266103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical