Provider Demographics
NPI:1598418618
Name:CENTENO BATALLA, YERITZA MARIA (MD)
Entity Type:Individual
Prefix:
First Name:YERITZA
Middle Name:MARIA
Last Name:CENTENO BATALLA
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:PO BOX 19237
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-1237
Mailing Address - Country:US
Mailing Address - Phone:787-268-4433
Mailing Address - Fax:
Practice Address - Street 1:1801 AVENIDA JUAN PONCE DE LEON
Practice Address - Street 2:SUITE 101-D
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-0236
Practice Address - Country:US
Practice Address - Phone:787-268-4433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PR23474208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program