MEDICARE: SUSANA YOJANIS RIVERA

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
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1518731413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANA YOJANIS RIVERA

Provider Business Mailing Address
First Line	:	4607 29TH ST APT 4
Second Line	:
City	:	MOUNT RAINIER
State	:	MD
Zip	:	20712-1311
Country	:	US
Telephone Number	:	202-677-8384
Fax Number	:

Provider Business Practice Location Address
First Line	:	1441 SPRING RD NW APT 102
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20010-1223
Country	:	US
Telephone Number	:	202-291-6861
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2023
Last Update Date	:	11/10/2023

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Directions to “ SUSANA YOJANIS RIVERA ” Practice Location

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