Healthcare Provider Details

I. General information

NPI: 1902037732
Provider Name (Legal Business Name): DANZA YADIRA RIVERA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2009
Last Update Date: 07/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PARQUE SAN MIGUEL CALLE 1 BLOQUE A-14
BAYAMON PUERTO RICO
00959
UM

IV. Provider business mailing address

PARQUE SAN MIGUEL CALLE 1 BLOQUE A-14
BAYAMON PUERTO RICO
00959
UM

V. Phone/Fax

Practice location:
  • Phone: 787-530-2490
  • Fax: 787-251-7583
Mailing address:
  • Phone: 787-530-2490
  • Fax: 787-251-7583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3029
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: