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General NPI Number Information
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NPI Number | 1225259591
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Entity Type | Individual
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Provider Name | YDSIA J RIVERA VAZQUEZ PSYD
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Gender | Female
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | AVENIDA AMERICO MIRANDA 1422 URB CAPARRA TERRACE
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City | SAN JUAN
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State | PR
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Zip | 00921
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Country | US
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Telephone | 787-783-8738
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Fax |
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Provider Business Mailing Address
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Address Line | 100 CALLE 5 APT C 11 UNIVERSAL PLAZA
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City | TRUJILLO ALTO
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State | PR
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Zip | 00976
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Country | US
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Telephone | 787-783-8738
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2139
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License Number State | PR
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