Provider Demographics
NPI:1033717343
Name:RIVERA GONZALEZ, YALIZETH KATIUSKA
Entity Type:Individual
Prefix:
First Name:YALIZETH
Middle Name:KATIUSKA
Last Name:RIVERA GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 23690
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-9032
Mailing Address - Country:US
Mailing Address - Phone:787-429-4576
Mailing Address - Fax:
Practice Address - Street 1:CARR 348 KM 7.2
Practice Address - Street 2:BO ROSARIO
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-429-4576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6693103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist