Healthcare Provider Details

I. General information

NPI: 1609214618
Provider Name (Legal Business Name): ALEXIS GONZALEZ RIVERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

'UNIVERSIDAD DE PR, RECINTO DE DEPARTAMENTO DE MEDICINA OCTAVO PISO OFICINA A838
SAN JUAN PR
00935-0001
US

IV. Provider business mailing address

6050 STREET 844 VILLAS DEL MONTE BOX 63
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-759-8252
  • Fax:
Mailing address:
  • Phone: 787-374-6257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License Number32780
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number19899
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: