Provider Demographics
NPI:1669144929
Name:GARCIA RIVAS, YADIRA ELIZABETH (SA-C)
Entity type:Individual
Prefix:
First Name:YADIRA
Middle Name:ELIZABETH
Last Name:GARCIA RIVAS
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 CROES AVE APT 1R
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-1434
Mailing Address - Country:US
Mailing Address - Phone:347-932-4964
Mailing Address - Fax:
Practice Address - Street 1:1414 CROES AVE APT 1R
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-1434
Practice Address - Country:US
Practice Address - Phone:347-932-4964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21-453246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant