Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | AZ |
NPI | 1104006394 |
---|---|
Provider Name | Ms. Yasmin Rivera |
First Address | Phoenix, AZ 85023-1402 |
Second Address | Phoenix, AZ 85023-1402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2007 |
Last Update Date | 06/11/2007 |