Provider Demographics
NPI:1588066500
Name:MENDOZA, KEILA YASIRIS (PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:KEILA
Middle Name:YASIRIS
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:A42 CALLE 1
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-4839
Mailing Address - Country:US
Mailing Address - Phone:787-674-6482
Mailing Address - Fax:
Practice Address - Street 1:54 CALLE PINERO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-3613
Practice Address - Country:US
Practice Address - Phone:787-767-3655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-22
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5368103TC1900X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist