Provider Demographics
NPI:1225457872
Name:RIVAUD, YAYONE LUCIA
Entity Type:Individual
Prefix:MS
First Name:YAYONE
Middle Name:LUCIA
Last Name:RIVAUD
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:PO BOX 678398
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8398
Mailing Address - Country:US
Mailing Address - Phone:800-475-6112
Mailing Address - Fax:706-653-1230
Practice Address - Street 1:801 OSTRUM ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1000
Practice Address - Country:US
Practice Address - Phone:484-526-4000
Practice Address - Fax:706-653-1230
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA109140002085R0202X
390200000X
PAMD4671532085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103764835Medicaid