Provider Demographics
NPI:1710860218
Name:PEREZ MANGUAL, YADIRA
Entity type:Individual
Prefix:
First Name:YADIRA
Middle Name:
Last Name:PEREZ MANGUAL
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:URB. VALLE HERMOSO ABAJO
Mailing Address - Street 2:CALLE AMAPOLA SN18
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660-1304
Mailing Address - Country:US
Mailing Address - Phone:787-306-8825
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 2 KM 157.9
Practice Address - Street 2:BARRIO SABALOS NUEVOS
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1522
Practice Address - Country:US
Practice Address - Phone:787-306-8825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004779101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health