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NPI Code Detail

MEDICARE: DR. YDALITH G RIVERA-PEREZ LP, PA-C

MEDICARE: DR. YDALITH G RIVERA-PEREZ LP, PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA2105TX
2103TC0700XClinical Psychologist38335TX

General Provider Information

NPI Number : 1023022647
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. YDALITH G RIVERA-PEREZ LP, PA-C
Provider Business Mailing Address
First Line : 8611 E WINDHAVEN TERRACE TRL
Second Line :
City : CYPRESS
State : TX
Zip : 77433-2751
Country : US
Telephone Number : 281-844-0161
Fax Number :
Provider Business Practice Location Address
First Line : 16225 PARK TEN PL STE 500
Second Line :
City : HOUSTON
State : TX
Zip : 77084-5152
Country : US
Telephone Number : 281-524-3894
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2006
Last Update Date : 09/10/2024

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