Provider Demographics
NPI:1932922531
Name:MEDINA, YARILIS MARIE
Entity type:Individual
Prefix:
First Name:YARILIS
Middle Name:MARIE
Last Name:MEDINA
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:CARR. 129 KM 1.0 SAN LUIS
Mailing Address - Street 2:HOSPITAL PAVIA
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613
Mailing Address - Country:US
Mailing Address - Phone:787-650-7272
Mailing Address - Fax:
Practice Address - Street 1:URB VISTA AZUL CALLE 7 G 30
Practice Address - Street 2:HOSPITAL PAVIA
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-214-1671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR166751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical