Healthcare Provider Details

I. General information

NPI: 1003814047
Provider Name (Legal Business Name): DR. GILBERTO RIVERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 10/05/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TORRE AUXILIO MUTUO PONCE DE LEON AVE 735 SUITE 408
SAN JUAN PR
00917
US

IV. Provider business mailing address

PO BOX 70250 SUITE 310
SAN JUAN PR
00936-8250
US

V. Phone/Fax

Practice location:
  • Phone: 787-227-0408
  • Fax: 787-229-0408
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number13225
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: