Provider Demographics
NPI:1508638149
Name:MEDINA, YAMIL MALAVE (PSY, D)
Entity Type:Individual
Prefix:DR
First Name:YAMIL
Middle Name:MALAVE
Last Name:MEDINA
Suffix:
Gender:M
Credentials:PSY, D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:864 AVE ASHFORD APT 814
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1025
Mailing Address - Country:US
Mailing Address - Phone:939-225-8020
Mailing Address - Fax:
Practice Address - Street 1:864 AVE ASHFORD
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1047
Practice Address - Country:US
Practice Address - Phone:939-225-8020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7566103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty