Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1093174443 |
---|---|
Provider Name | Blanca Rivera |
First Address | Pembroke Pines, FL 33025-5509 |
Second Address | Pembroke Pines, FL 33025-5509 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2016 |
Last Update Date | 14/02/2016 |