Healthcare Provider Details

I. General information

NPI: 1346436847
Provider Name (Legal Business Name): GABRIEL RIVERA VELAZQUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: GABRIEL RIVERA VELAZQUEZ M.D.

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 11/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 AVE PONCE DE LEON PARADA 37 PISO 2 DEPT DE RADIOLOGIA INVASIVA
SAN JUAN PR
00918
US

IV. Provider business mailing address

675 CALLE S CUEVAS BUSTAMANTE APT 1702, BOX114
SAN JUAN PR
00918-4090
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2000
  • Fax:
Mailing address:
  • Phone: 787-405-0275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number20574
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number20574
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: