Provider Demographics
NPI:1053919027
Name:INIGO, EYDA YESMIN (PHSYDC)
Entity type:Individual
Prefix:
First Name:EYDA
Middle Name:YESMIN
Last Name:INIGO
Suffix:
Gender:F
Credentials:PHSYDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. COLINAS DE ALTURAS DE MAYAGUEZ 2020
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:939-247-5911
Mailing Address - Fax:
Practice Address - Street 1:URB. COLINAS DE ALTURAS DE MAYAGUEZ 2020
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:939-247-5911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6652103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling