Provider Demographics
NPI:1346990611
Name:CORTIJO RIVERA, AYANARA
Entity Type:Individual
Prefix:
First Name:AYANARA
Middle Name:
Last Name:CORTIJO RIVERA
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 1:22004 LINDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1628
Mailing Address - Country:US
Mailing Address - Phone:718-712-3358
Mailing Address - Fax:
Practice Address - Street 1:2848 DECATUR AVE # C
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-2904
Practice Address - Country:US
Practice Address - Phone:347-673-9626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator