Provider Demographics
NPI:1952038010
Name:OSTOLAZA OQUENDO, KYARA M
Entity Type:Individual
Prefix:
First Name:KYARA
Middle Name:M
Last Name:OSTOLAZA OQUENDO
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:AVENIDA ROOSEVELT 1484 CONDOMINIO BORINQUEN TOWERS
Mailing Address - Street 2:EDIF #1 APT 703
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920
Mailing Address - Country:US
Mailing Address - Phone:787-387-4717
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA ROOSEVELT 1484 CONDOMINIO BORINQUEN TOWERS
Practice Address - Street 2:EDIF #1 APT 703
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920
Practice Address - Country:US
Practice Address - Phone:787-387-4717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program