Healthcare Provider Details

I. General information

NPI: 1366868770
Provider Name (Legal Business Name): YELITZA M RIVERA SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2014
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 SW 1ST ST
MIAMI FL
33135-2202
US

IV. Provider business mailing address

1441 SW 1ST ST
MIAMI FL
33135-2202
US

V. Phone/Fax

Practice location:
  • Phone: 305-541-3400
  • Fax: 305-541-3344
Mailing address:
  • Phone: 305-541-3400
  • Fax: 305-541-3344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2060
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: