Provider Demographics
NPI:1639390891
Name:HUERTAS, YOLANDA IVETTE (MASTER)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:IVETTE
Last Name:HUERTAS
Suffix:
Gender:F
Credentials:MASTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 177, GUAYNABO, P.R
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970
Mailing Address - Country:US
Mailing Address - Phone:787-720-2676
Mailing Address - Fax:787-268-1671
Practice Address - Street 1:RESIDENCIAL LLOR'ENS TORRES, EDIF. ADMINISTRACION EL ME
Practice Address - Street 2:
Practice Address - City:SANJUAN
Practice Address - State:PR
Practice Address - Zip Code:00913
Practice Address - Country:US
Practice Address - Phone:787-268-1680
Practice Address - Fax:787-268-1671
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR61561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical