Healthcare Provider Details

I. General information

NPI: 1710548193
Provider Name (Legal Business Name): ARNALDO ANDRES RIVERA GORDON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 CALLE PROF AUGUSTO RODRIGUEZ STE 600
SAN JUAN PR
00909-2275
US

IV. Provider business mailing address

1503 CALLE PROF AUGUSTO RODRIGUEZ STE 600
SAN JUAN PR
00909-2275
US

V. Phone/Fax

Practice location:
  • Phone: 787-497-0800
  • Fax: 787-982-6464
Mailing address:
  • Phone: 787-497-0800
  • Fax: 787-982-6464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number85597
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: