MEDICARE: DR. HENRY GONZALEZ-RIVERA 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
1	207RG0100X	Gastroenterology Physician	12278	PR

General Provider Information

NPI Number	:	1770586265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRY GONZALEZ-RIVERA M.D.

Provider Business Mailing Address
First Line	:	130 AVE WINSTON CHURCHILL
Second Line	:	SUITE 1 PMB 335
City	:	SAN JUAN
State	:	PR
Zip	:	00926-6065
Country	:	US
Telephone Number	:	787-765-1041
Fax Number	:	787-765-6197

Provider Business Practice Location Address
First Line	:	200 AVE W CHURCHILL
Second Line	:	STE 201
City	:	SAN JUAN
State	:	PR
Zip	:	00926-6652
Country	:	US
Telephone Number	:	787-765-1041
Fax Number	:	787-765-6197

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	05/23/2008

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