Healthcare Provider Details

I. General information

NPI: 1043678964
Provider Name (Legal Business Name): AMARYLIS RIVAS SPLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2016
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 E OAK RIDGE RD STE 2
ORLANDO FL
32809-4266
US

IV. Provider business mailing address

1243 SAXON BLVD
DELTONA FL
32725-5971
US

V. Phone/Fax

Practice location:
  • Phone: 321-400-7535
  • Fax:
Mailing address:
  • Phone: 321-946-3932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI2295
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: