Basic Information
| Provider Information | |||||||||
| NPI: | 1447451505 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURGOS | ||||||||
| FirstName: | YANIRA | ||||||||
| MiddleName: | RAQUEL | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | B.S.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | URB. LOS ALMENDROS CALLE 4 G-15 | ||||||||
| Address2: | |||||||||
| City: | MAUNABO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872068504 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | AVE. KENNEDY | ||||||||
| Address2: | 8 | ||||||||
| City: | MAUNABO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878611407 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WE0003X | 29954 | PR | Y | Nursing Service Providers | Registered Nurse | Emergency |
No ID Information.