MEDICARE: MISS GAUDYS 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	172V00000X	Community Health Worker	OT-0005159	FL

General Provider Information

NPI Number	:	1720369879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS GAUDYS RIVAS

Provider Business Mailing Address
First Line	:	6269 NW 171 ST
Second Line	:
City	:	MIAMI LAKE
State	:	FL
Zip	:	33015
Country	:	US
Telephone Number	:	305-469-3232
Fax Number	:

Provider Business Practice Location Address
First Line	:	6269 NW 171ST ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-4622
Country	:	US
Telephone Number	:	305-469-3232
Fax Number	:

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

Provider Enumeration Date	:	09/02/2011
Last Update Date	:	09/02/2011

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Directions to “ MISS GAUDYS RIVAS ” Practice Location

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