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General NPI Number Information
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NPI Number | 1770586265
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Entity Type | Individual
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Provider Name | HENRY GONZALEZ-RIVERA M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 05/23/2008
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Provider Practice Location Address
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Address Line | 200 AVE W CHURCHILL STE 201
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City | SAN JUAN
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State | PR
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Zip | 00926-6652
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Country | US
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Telephone | 787-765-1041
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Fax | 787-765-6197
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Provider Business Mailing Address
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Address Line | 130 AVE WINSTON CHURCHILL SUITE 1 PMB 335
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City | SAN JUAN
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State | PR
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Zip | 00926-6065
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Country | US
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Telephone | 787-765-1041
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Fax | 787-765-6197
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 12278
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License Number State | PR
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