Provider Demographics
NPI:1962671065
Name:DE CARVALHO, RIVANEIDE SILVA
Entity type:Individual
Prefix:MRS
First Name:RIVANEIDE
Middle Name:SILVA
Last Name:DE CARVALHO
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 1:3120 W LAREDO ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-2323
Mailing Address - Country:US
Mailing Address - Phone:602-757-9221
Mailing Address - Fax:480-917-8090
Practice Address - Street 1:3120 W LAREDO ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-2323
Practice Address - Country:US
Practice Address - Phone:602-757-9221
Practice Address - Fax:480-917-8090
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD03853897172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker