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General NPI Number Information
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NPI Number | 1417191859
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Entity Type | Individual
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Provider Name | YAISELLE RIVERA CRNA
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Gender | Female
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Dates
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Enumeration Date | 04/29/2009
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Last Update Date | 12/21/2016
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Provider Practice Location Address
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Address Line | 10 CALLE CASIA
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City | SAN JUAN
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State | PR
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Zip | 00921-3200
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Country | US
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Telephone | 787-232-8797
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Fax |
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Provider Business Mailing Address
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Address Line | MANSIONES DEL TOA CALLE 5 E8
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City | TOA ALTA
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State | PR
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Zip | 00953
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Country | US
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Telephone | 787-232-8797
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 072658
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 72658
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License Number State | PR
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