Provider Demographics
NPI:1033555008
Name:KAVITZ, YADRIANA MARIA (STUDENT)
Entity Type:Individual
Prefix:MRS
First Name:YADRIANA
Middle Name:MARIA
Last Name:KAVITZ
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11754A ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:FORT DRUM
Mailing Address - State:NY
Mailing Address - Zip Code:13603-3125
Mailing Address - Country:US
Mailing Address - Phone:315-286-3261
Mailing Address - Fax:
Practice Address - Street 1:11754A ORCHARD DR
Practice Address - Street 2:
Practice Address - City:FORT DRUM
Practice Address - State:NY
Practice Address - Zip Code:13603-3125
Practice Address - Country:US
Practice Address - Phone:315-286-3261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041S0200X390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program