Provider Demographics
NPI:1265294094
Name:RIVERA CAMACHO, YARIELIS (MS)
Entity type:Individual
Prefix:MS
First Name:YARIELIS
Middle Name:
Last Name:RIVERA CAMACHO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 6036
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-9662
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CARR. 806 KM 0.8
Practice Address - Street 2:QUEBRADA ARENAS
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-9662
Practice Address - Country:US
Practice Address - Phone:787-628-7982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7850103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling