Healthcare Provider Details

I. General information

NPI: 1144151036
Provider Name (Legal Business Name): KARLA BEATRIZ RIVAS GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 BROADWAY
BROOKLYN NY
11206-5317
US

IV. Provider business mailing address

614 BAINBRIDGE ST APT 1
BROOKLYN NY
11233-5880
US

V. Phone/Fax

Practice location:
  • Phone: 718-963-8188
  • Fax:
Mailing address:
  • Phone: 786-491-4878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number343697
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: