1245789494 NPI number — DR. LYZAIDA IVETTE RIVERA-BAUER PH.D.

Table of content: DR. LYZAIDA IVETTE RIVERA-BAUER PH.D. (NPI 1245789494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245789494 NPI number — DR. LYZAIDA IVETTE RIVERA-BAUER PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVERA-BAUER
Provider First Name:
LYZAIDA
Provider Middle Name:
IVETTE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RIVERA
Provider Other First Name:
LYZAIDA
Provider Other Middle Name:
IVETTE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245789494
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1655 FORT MYER DR
Provider Second Line Business Mailing Address:
820
Provider Business Mailing Address City Name:
ROSSLYN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22209-3113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1655 FORT MYER DR
Provider Second Line Business Practice Location Address:
820
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22209-3113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-321-3910
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/29/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  0810006029 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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