Provider Demographics
NPI:1972364289
Name:MARRERO RODRIGUEZ, YIRALIZ SHAITZA
Entity Type:Individual
Prefix:
First Name:YIRALIZ
Middle Name:SHAITZA
Last Name:MARRERO RODRIGUEZ
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:RR 2 BOX 4641
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-9676
Mailing Address - Country:US
Mailing Address - Phone:787-922-7503
Mailing Address - Fax:
Practice Address - Street 1:URBANIZACION LAS VILLAS CALLE PAZ
Practice Address - Street 2:CASA 41
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-9676
Practice Address - Country:US
Practice Address - Phone:787-922-7503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7711103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist