Provider Demographics
NPI:1295270577
Name:PEREZ CARABALLO, YESENIA (NURSE)
Entity type:Individual
Prefix:MISS
First Name:YESENIA
Middle Name:
Last Name:PEREZ CARABALLO
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41611 BARRIO SAN ANTONIO
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-9486
Mailing Address - Country:US
Mailing Address - Phone:787-320-2437
Mailing Address - Fax:
Practice Address - Street 1:41611 BARRIO SAN ANTONIO
Practice Address - Street 2:SECTOR EL FOSFORO
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678-9486
Practice Address - Country:US
Practice Address - Phone:787-454-6864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-22
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR76290G163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse