Provider Demographics
NPI:1285332858
Name:RIVAS, NYDIA YAIMI
Entity type:Individual
Prefix:
First Name:NYDIA
Middle Name:YAIMI
Last Name:RIVAS
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 1:125 SALIDA MOROVIS
Mailing Address - Street 2:
Mailing Address - City:OROCOVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00720-4558
Mailing Address - Country:US
Mailing Address - Phone:787-484-3960
Mailing Address - Fax:
Practice Address - Street 1:URB EL BOSQUE DE COAMO
Practice Address - Street 2:24 CARR 704 KM 3.0
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769
Practice Address - Country:US
Practice Address - Phone:787-484-3960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR118981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical