Provider Demographics
NPI:1477786366
Name:RIVERA, YADIRA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:YADIRA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CALLE VENUS
Mailing Address - Street 2:URB. SANTA ANA
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637-1531
Mailing Address - Country:US
Mailing Address - Phone:787-951-7387
Mailing Address - Fax:
Practice Address - Street 1:7 CALLE VENUS
Practice Address - Street 2:URB. SANTA ANA
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637-1531
Practice Address - Country:US
Practice Address - Phone:787-951-7387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR678235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist