Provider Demographics
NPI:1720758071
Name:RIVERA-GONZALEZ, YANIS
Entity Type:Individual
Prefix:
First Name:YANIS
Middle Name:
Last Name:RIVERA-GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YANIS
Other - Middle Name:
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:705 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1121
Mailing Address - Country:US
Mailing Address - Phone:407-391-9033
Mailing Address - Fax:
Practice Address - Street 1:705 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1121
Practice Address - Country:US
Practice Address - Phone:407-391-9033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator