Provider Demographics
NPI:1386964534
Name:MANON MARTINEZ, YASMIR
Entity type:Individual
Prefix:
First Name:YASMIR
Middle Name:
Last Name:MANON MARTINEZ
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 1:231-26 CALLE 610
Mailing Address - Street 2:VILLA CAROLINA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-2223
Mailing Address - Country:US
Mailing Address - Phone:939-717-4302
Mailing Address - Fax:
Practice Address - Street 1:231-26 CALLE 610
Practice Address - Street 2:VILLA CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-2223
Practice Address - Country:US
Practice Address - Phone:939-717-4302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2868103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2868OtherLICENCIA