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NPI Code Detail

MEDICARE: JANIVETTE RIVERA GONZALEZ M.D.

MEDICARE: JANIVETTE RIVERA GONZALEZ M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist13859PR

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
121476OTHERPRMEDICARE

General Provider Information

NPI Number : 1659370872
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANIVETTE RIVERA GONZALEZ M.D.
Provider Business Mailing Address
First Line : PO BOX 2329
Second Line :
City : COAMO
State : PR
Zip : 00769-4329
Country : US
Telephone Number : 787-385-7019
Fax Number : 787-845-4044
Provider Business Practice Location Address
First Line : 809 CARR 153 STE 13
Second Line : PLAZA SANTA ISABEL
City : SANTA ISABEL
State : PR
Zip : 00757-4009
Country : US
Telephone Number : 787-845-4044
Fax Number : 787-845-4044
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2005
Last Update Date : 08/30/2024

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