Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MT212134 | PA |
Y | 111NI0900X | Internist | MT212134 | PA |
NPI | 1003269242 |
---|---|
Provider Name | Dr. Yulia Rivelis |
First Address | Philadelphia, PA 19102 |
Second Address | Philadelphia, PA 19102-1101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2016 |
Last Update Date | 22/07/2016 |