Provider Demographics
NPI:1205046976
Name:RIVERA, WANDA YADIRA (DRA)
Entity type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:YADIRA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:DRA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-0186
Mailing Address - Country:US
Mailing Address - Phone:787-269-3601
Mailing Address - Fax:787-767-7806
Practice Address - Street 1:CALLE GUARIONEX #7
Practice Address - Street 2:LOCAL 2
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-269-3601
Practice Address - Fax:787-767-7806
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR192103TA0400X
PR978103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling