Healthcare Provider Details

I. General information

NPI: 1760568612
Provider Name (Legal Business Name): YOLANDA RIVAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 BAINBRIDGE AVENUE CHILDREN'S HOSPITAL AT MONTEFIORE
BRONX NY
10467
US

IV. Provider business mailing address

3415 BAINBRIDGE AVE
BRONX NY
10467-2403
US

V. Phone/Fax

Practice location:
  • Phone: 718-741-2450
  • Fax: 718-920-5426
Mailing address:
  • Phone: 718-741-2450
  • Fax: 718-920-5426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number198374
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: