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General NPI Number Information
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NPI Number | 1033717343
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Entity Type | Individual
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Provider Name | YALIZETH KATIUSKA RIVERA GONZALEZ
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Gender | Female
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Dates
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Enumeration Date | 10/09/2020
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Last Update Date | 10/09/2020
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Provider Practice Location Address
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Address Line | CARR 348 KM 7.2 BO ROSARIO
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City | MAYAGUEZ
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State | PR
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Zip | 00680
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Country | US
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Telephone | 787-429-4576
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Fax |
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Provider Business Mailing Address
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Address Line | HC 2 BOX 23690
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City | MAYAGUEZ
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State | PR
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Zip | 00680-9032
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Country | US
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Telephone | 787-429-4576
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6693
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License Number State | PR
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