Provider Demographics
NPI:1346436847
Name:RIVERA VELAZQUEZ, GABRIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:
Last Name:RIVERA VELAZQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GABRIEL
Other - Middle Name:
Other - Last Name:RIVERA VELAZQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:675 CALLE S CUEVAS BUSTAMANTE
Mailing Address - Street 2:APT 1702, BOX114
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-4090
Mailing Address - Country:US
Mailing Address - Phone:787-405-0275
Mailing Address - Fax:
Practice Address - Street 1:715 AVE PONCE DE LEON PARADA 37
Practice Address - Street 2:PISO 2 DEPT DE RADIOLOGIA INVASIVA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-758-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR205742085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology