MEDICARE: DR. ANTONIO RIUTORT-GONZALEZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	5427	PR

General Provider Information

NPI Number	:	1629078456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTONIO RIUTORT-GONZALEZ M.D.

Provider Business Mailing Address
First Line	:	1475 CALLE WILSON
Second Line	:	WILSON MEDICAL BLDG. OFFICE 2-A
City	:	SAN JUAN
State	:	PR
Zip	:	00907-2357
Country	:	US
Telephone Number	:	787-728-4957
Fax Number	:	787-728-1635

Provider Business Practice Location Address
First Line	:	1475 CALLE WILSON
Second Line	:	WILSON MEDICAL BLDG. OFFICE 2-A
City	:	SAN JUAN
State	:	PR
Zip	:	00907-2357
Country	:	US
Telephone Number	:	787-728-4957
Fax Number	:	787-728-1635

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	05/27/2026

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