Provider Demographics
NPI:1164011318
Name:PEREZ RIVERA, YANIRA (DC)
Entity Type:Individual
Prefix:
First Name:YANIRA
Middle Name:
Last Name:PEREZ RIVERA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 FOX HILL RD STE C
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-1780
Mailing Address - Country:US
Mailing Address - Phone:757-850-0500
Mailing Address - Fax:
Practice Address - Street 1:208 FOX HILL RD STE C
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-1780
Practice Address - Country:US
Practice Address - Phone:757-850-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104-557708111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor