=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528584232
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | INDHIRA M RIVAS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2017
-----------------------------------------------------
Last Update Date | 08/15/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1551 CALLE VICTORIA SANTURCE
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-722-9595
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | ST. 18 Q53 VILLAS DE LOIZA
-----------------------------------------------------
City | CANOVANAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00729-4258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-550-3369
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TS0200X
-----------------------------------------------------
Taxonomy Name | School Psychologist
-----------------------------------------------------
License Number | 5542
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------