Healthcare Provider Details

I. General information

NPI: 1124074323
Provider Name (Legal Business Name): JUAN A RIVERA GONZALEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 08/06/2007
Certification Date:
Deactivation Date: 07/17/2007
Reactivation Date: 08/06/2007

III. Provider practice location address

UNIVERSITY PEDIATRIC HOSPITAL 6TH FLOOR NEONATOLOGY SECTION
SAN JUAN PR
00919-1079
US

IV. Provider business mailing address

URB TERRANOBA ST 1 G1
GUAYNABO PR
00969
US

V. Phone/Fax

Practice location:
  • Phone: 787-777-3225
  • Fax: 787-758-5307
Mailing address:
  • Phone: 787-708-2243
  • Fax: 787-708-2243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number12398
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: