Provider Demographics
NPI:1124898101
Name:SANTOS MONSERRATE, YARIDIS D
Entity type:Individual
Prefix:
First Name:YARIDIS
Middle Name:D
Last Name:SANTOS MONSERRATE
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 1:13 CALLE VENUS
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-3223
Mailing Address - Country:US
Mailing Address - Phone:787-236-6470
Mailing Address - Fax:
Practice Address - Street 1:CARR. NO.2 KM 8.2
Practice Address - Street 2:BO. JUAN SANCHEZ
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960
Practice Address - Country:US
Practice Address - Phone:787-763-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-02
Last Update Date:2024-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7078103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling