Healthcare Provider Details

I. General information

NPI: 1659370872
Provider Name (Legal Business Name): JANIVETTE RIVERA GONZALEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 CARR 153 STE 13 PLAZA SANTA ISABEL
SANTA ISABEL PR
00757-4009
US

IV. Provider business mailing address

PO BOX 2329
COAMO PR
00769-4329
US

V. Phone/Fax

Practice location:
  • Phone: 787-845-4044
  • Fax: 787-845-4044
Mailing address:
  • Phone: 787-385-7019
  • Fax: 787-845-4044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number13859
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: