Healthcare Provider Details

I. General information

NPI: 1306386578
Provider Name (Legal Business Name): RADAMES VICENTE RIOS GONZALEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2017
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 AVE ANTONIO R BARCELO STE 5
CAYEY PR
00736-4132
US

IV. Provider business mailing address

151 CALLE CESAR GONZALEZ APT 503
SAN JUAN PR
00918-5103
US

V. Phone/Fax

Practice location:
  • Phone: 787-307-2828
  • Fax:
Mailing address:
  • Phone: 787-438-9839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number322102
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number23754
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number23754
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: