Provider Demographics
NPI:1003814047
Name:RIVERA, GILBERTO
Entity Type:Individual
Prefix:DR
First Name:GILBERTO
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70250
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8250
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:TORRE AUXILIO MUTUO PONCE DE LEON AVE 735
Practice Address - Street 2:SUITE 408
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-227-0408
Practice Address - Fax:787-229-0408
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13225207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR21475Medicare ID - Type Unspecified
PRH93413Medicare UPIN