Provider Demographics
NPI:1396182507
Name:BURGOS, YAMELITTE
Entity Type:Individual
Prefix:MRS
First Name:YAMELITTE
Middle Name:
Last Name:BURGOS
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:PO BOX 82
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00737
Mailing Address - Country:UM
Mailing Address - Phone:787-447-4033
Mailing Address - Fax:
Practice Address - Street 1:URB. REPARTO MONTELLANO
Practice Address - Street 2:CALLE A I-39
Practice Address - City:CAYEY
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00737
Practice Address - Country:UM
Practice Address - Phone:787-447-4033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR104671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical