Provider Demographics
NPI:1831896463
Name:RIVERA COMAS, VIVIAN
Entity type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:
Last Name:RIVERA COMAS
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 1:2010 S WESTMORELAND DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-5310
Mailing Address - Country:US
Mailing Address - Phone:862-237-6101
Mailing Address - Fax:
Practice Address - Street 1:3501 W VINE ST STE 273
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4673
Practice Address - Country:US
Practice Address - Phone:407-818-7201
Practice Address - Fax:727-313-9253
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician