Provider Demographics
NPI:1336502541
Name:PEREZ MATEO, YANITZA
Entity Type:Individual
Prefix:
First Name:YANITZA
Middle Name:
Last Name:PEREZ MATEO
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 1:1 CALLE GUAYABO 127
Mailing Address - Street 2:URB. PROVINCIAS DEL RIO
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-4930
Mailing Address - Country:US
Mailing Address - Phone:787-420-7102
Mailing Address - Fax:
Practice Address - Street 1:ESTATAL 54 KM 0.9
Practice Address - Street 2:LA FUENTE TOWN CENTER SUITE 222
Practice Address - City:GAUYAMA
Practice Address - State:PR
Practice Address - Zip Code:00785-0360
Practice Address - Country:US
Practice Address - Phone:787-961-3993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5104163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse