=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154636462
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GLORIMAR RIVERA COLON M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2010
-----------------------------------------------------
Last Update Date | 11/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3417 GASTON AVE STE 630
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75246-2030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-800-9000
-----------------------------------------------------
Fax | 469-800-9010
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 844658
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75284-4658
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-994-0371
-----------------------------------------------------
Fax | 254-215-9722
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number | Q6363
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | Q6363
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------