MEDICARE: YASMIN MACARIO 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	2355A2700X	Audiology Assistant	371	CA

General Provider Information

NPI Number	:	1619166386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YASMIN MACARIO RIVERA

Provider Business Mailing Address
First Line	:	5721 MANTON AVE
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-3032
Country	:	US
Telephone Number	:	818-635-8166
Fax Number	:

Provider Business Practice Location Address
First Line	:	5721 MANTON AVE
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-3032
Country	:	US
Telephone Number	:	818-635-8166
Fax Number	:

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

Provider Enumeration Date	:	10/18/2007
Last Update Date	:	10/18/2007

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Directions to “ YASMIN MACARIO RIVERA ” Practice Location

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