Provider Demographics
NPI:1447712468
Name:AGUASVIVAS, EVELYN Z
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:Z
Last Name:AGUASVIVAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 WALNUT ST # 1
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07522-1426
Mailing Address - Country:US
Mailing Address - Phone:973-460-1866
Mailing Address - Fax:
Practice Address - Street 1:174 WALNUT ST # 1
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07522-1426
Practice Address - Country:US
Practice Address - Phone:973-460-1866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator