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General NPI Number Information
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NPI Number | 1366434151
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Entity Type | Individual
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Provider Name | GABRIEL RIVERA-RODRIGUEZ MD
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Gender | Male
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Dates
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Enumeration Date | 08/17/2005
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Last Update Date | 09/20/2013
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Provider Practice Location Address
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Address Line | 1111 MEDICAL CENTER BLVD SUITE N511
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City | MARRERO
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State | LA
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Zip | 70072-3151
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Country | US
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Telephone | 504-349-6301
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Fax | 504-349-6308
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Provider Business Mailing Address
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Address Line | 4409 UTICA ST SUITE 100
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City | METAIRIE
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State | LA
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Zip | 70006-6530
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Country | US
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Telephone | 504-457-3687
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Fax | 504-620-0250
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 10953R
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License Number State | LA
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