Provider Demographics
NPI:1972143113
Name:TOLENTINO FELIX, YARISSA M
Entity Type:Individual
Prefix:
First Name:YARISSA
Middle Name:M
Last Name:TOLENTINO FELIX
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 1:560 CALLE NAPOLES APT 19M
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-4009
Mailing Address - Country:US
Mailing Address - Phone:787-630-2800
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSIDAD ANA G. MENDEZ
Practice Address - Street 2:EDIFICIO KINGBIRD INNOVATION CENTER SUITE 4
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:939-223-8333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9069101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty