Provider Demographics
NPI:1669845350
Name:MARTINEZ QUILES, MYLADIE
Entity Type:Individual
Prefix:
First Name:MYLADIE
Middle Name:
Last Name:MARTINEZ QUILES
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:AVE. HOSTOS 2625
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-6326
Mailing Address - Country:US
Mailing Address - Phone:787-923-0019
Mailing Address - Fax:
Practice Address - Street 1:VALLEY HILLS PROFESSIONAL CENTER
Practice Address - Street 2:LOCAL 5 CARR 402 KM 2.9
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610-2017
Practice Address - Country:US
Practice Address - Phone:787-400-5484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3259103TC1900X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool