Provider Demographics
NPI:1336687375
Name:VIRELLA PEREZ, YISSELLE ILENE (MD)
Entity Type:Individual
Prefix:
First Name:YISSELLE
Middle Name:ILENE
Last Name:VIRELLA PEREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4046 CALLE SANTA CATALINA
Mailing Address - Street 2:URB SANTA TERESITA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-4620
Mailing Address - Country:US
Mailing Address - Phone:787-410-1675
Mailing Address - Fax:
Practice Address - Street 1:4046 CALLE SANTA CATALINA
Practice Address - Street 2:URB SANTA TERESITA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-4620
Practice Address - Country:US
Practice Address - Phone:787-410-1675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program