Provider Demographics
NPI:1922524552
Name:AYALA RIVERA, ADINA MARIA
Entity Type:Individual
Prefix:
First Name:ADINA
Middle Name:MARIA
Last Name:AYALA 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 1:1705 W 41ST ST APT 3
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7023
Mailing Address - Country:US
Mailing Address - Phone:786-337-3077
Mailing Address - Fax:
Practice Address - Street 1:717 PONCE DE LEON BLVD STE 307
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2070
Practice Address - Country:US
Practice Address - Phone:305-619-3202
Practice Address - Fax:305-463-6690
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty