Provider Demographics
NPI:1720369879
Name:RIVAS, GAUDYS
Entity Type:Individual
Prefix:MISS
First Name:GAUDYS
Middle Name:
Last Name:RIVAS
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 1:6269 NW 171 ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:33015
Mailing Address - Country:US
Mailing Address - Phone:305-469-3232
Mailing Address - Fax:
Practice Address - Street 1:6269 NW 171ST ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-4622
Practice Address - Country:US
Practice Address - Phone:305-469-3232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT-0005159172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker