Provider Demographics
NPI:1225259591
Name:RIVERA VAZQUEZ, YDSIA J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:YDSIA
Middle Name:J
Last Name:RIVERA VAZQUEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CALLE 5
Mailing Address - Street 2:APT C 11 UNIVERSAL PLAZA
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-783-8738
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA AMERICO MIRANDA 1422
Practice Address - Street 2:URB CAPARRA TERRACE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-783-8738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2139103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR219168OtherPREFERRED HEALTH
PRA644OtherFIRST MEDICAL
PR3185OtherAPS