Provider Demographics
NPI:1518731413
Name:RIVERA, SUSANA YOJANIS
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:YOJANIS
Last Name: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 1:4607 29TH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-1311
Mailing Address - Country:US
Mailing Address - Phone:202-677-8384
Mailing Address - Fax:
Practice Address - Street 1:1441 SPRING RD NW APT 102
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-1223
Practice Address - Country:US
Practice Address - Phone:202-291-6861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant