Provider Demographics
NPI:1477152528
Name:PAULINO, YAHAIRA MARIA
Entity Type:Individual
Prefix:
First Name:YAHAIRA
Middle Name:MARIA
Last Name:PAULINO
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 1:617 W 141ST ST APT 56
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-6957
Mailing Address - Country:US
Mailing Address - Phone:646-301-8734
Mailing Address - Fax:
Practice Address - Street 1:617 W 141ST ST APT 56
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-6957
Practice Address - Country:US
Practice Address - Phone:646-301-8734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031143-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist