Healthcare Provider Details

I. General information

NPI: 1629078456
Provider Name (Legal Business Name): ANTONIO RIUTORT-GONZALEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 CALLE WILSON WILSON MEDICAL BLDG. OFFICE 2-A
SAN JUAN PR
00907-2357
US

IV. Provider business mailing address

1475 CALLE WILSON WILSON MEDICAL BLDG. OFFICE 2-A
SAN JUAN PR
00907-2357
US

V. Phone/Fax

Practice location:
  • Phone: 787-728-4957
  • Fax: 787-728-1635
Mailing address:
  • Phone: 787-728-4957
  • Fax: 787-728-1635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number5427
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: