Provider Demographics
NPI:1386399640
Name:PLAZA PAGAN, YAIRLEIN MARY (PHD)
Entity type:Individual
Prefix:DR
First Name:YAIRLEIN
Middle Name:MARY
Last Name:PLAZA PAGAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 AVE TITO CASTRO STE 102
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-0200
Mailing Address - Country:US
Mailing Address - Phone:939-201-8926
Mailing Address - Fax:
Practice Address - Street 1:BLVD. LUIS A. FERR EDIFICIO PORRATA PILA
Practice Address - Street 2:SUITE 208 #2431
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717
Practice Address - Country:US
Practice Address - Phone:939-201-8926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6875103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical