Provider Demographics
NPI:1285064659
Name:PADILLA DALMAU, YANIZ CRISTINA
Entity type:Individual
Prefix:
First Name:YANIZ
Middle Name:CRISTINA
Last Name:PADILLA DALMAU
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1473 AVE WILSON STE 304
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-2364
Mailing Address - Country:US
Mailing Address - Phone:787-489-0088
Mailing Address - Fax:
Practice Address - Street 1:1473 AVE WILSON STE 304
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-2364
Practice Address - Country:US
Practice Address - Phone:787-489-0088
Practice Address - Fax:787-489-0088
Is Sole Proprietor?:No
Enumeration Date:2013-11-20
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7653103T00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1825Medicaid