MEDICARE: YAZMIN RIVERA BA

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1851768782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAZMIN RIVERA BA

Provider Business Mailing Address
First Line	:	4666 LORI CHRISTINE ST
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33844-9037
Country	:	US
Telephone Number	:	407-655-8175
Fax Number	:

Provider Business Practice Location Address
First Line	:	4666 LORI CHRISTINE ST
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33844-9037
Country	:	US
Telephone Number	:	407-655-8175
Fax Number	:

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

Provider Enumeration Date	:	08/26/2015
Last Update Date	:	08/26/2015

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Directions to “ YAZMIN RIVERA BA” Practice Location

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