Provider Demographics
NPI:1922153717
Name:RIVAS VAZQUEZ, ANA (PHD)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:RIVAS VAZQUEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1385 CORAL WAY STE 402
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2941
Mailing Address - Country:US
Mailing Address - Phone:305-858-3085
Mailing Address - Fax:
Practice Address - Street 1:1385 CORAL WAY STE 402
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2941
Practice Address - Country:US
Practice Address - Phone:305-858-3085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74106Medicare ID - Type Unspecified