Basic Information
| Provider Information | |||||||||
| NPI: | 1568425304 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIVAS-VAZQUEZ | ||||||||
| FirstName: | RAFAEL | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9960 NW 116TH WAY | ||||||||
| Address2: | SUITE 13 | ||||||||
| City: | MEDLEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331781167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7869241311 | ||||||||
| FaxNumber: | 7869241313 | ||||||||
| Practice Location | |||||||||
| Address1: | 8940 N KENDALL DR | ||||||||
| Address2: | SUITE 802E | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331762148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055954041 | ||||||||
| FaxNumber: | 3055956638 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2006 | ||||||||
| LastUpdateDate: | 03/25/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | PY4519 | FL | Y | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
No ID Information.