Provider Demographics
NPI:1407361785
Name:RIVERA RODRIGUEZ, ANA RIVERA (PHD CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:ANA
Middle Name:RIVERA
Last Name:RIVERA RODRIGUEZ
Suffix:
Gender:F
Credentials:PHD CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 MAGNOLIA PARK TRL
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-7215
Mailing Address - Country:US
Mailing Address - Phone:321-262-9463
Mailing Address - Fax:
Practice Address - Street 1:279 MAGNOLIA PARK TRL
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-7215
Practice Address - Country:US
Practice Address - Phone:321-262-9463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10845235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist