MEDICARE: INDHIRA M RIVAS

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	103TS0200X	School Psychologist	5542	PR

General Provider Information

NPI Number	:	1528584232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INDHIRA M RIVAS

Provider Business Mailing Address
First Line	:	ST. 18 Q53
Second Line	:	VILLAS DE LOIZA
City	:	CANOVANAS
State	:	PR
Zip	:	00729-4258
Country	:	US
Telephone Number	:	787-550-3369
Fax Number	:

Provider Business Practice Location Address
First Line	:	1551 CALLE VICTORIA SANTURCE
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00912
Country	:	US
Telephone Number	:	787-722-9595
Fax Number	:

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

Provider Enumeration Date	:	08/15/2017
Last Update Date	:	08/15/2017

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Directions to “ INDHIRA M RIVAS ” Practice Location

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