Provider Demographics
NPI:1659877892
Name:RIVERA, YAN A
Entity Type:Individual
Prefix:
First Name:YAN
Middle Name:A
Last Name:RIVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 NE 5TH ST APT 203
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-7638
Mailing Address - Country:US
Mailing Address - Phone:786-366-6908
Mailing Address - Fax:
Practice Address - Street 1:3330 NE 5TH ST APT 203
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7638
Practice Address - Country:US
Practice Address - Phone:786-366-6908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty