Provider Demographics
NPI:1629078456
Name:RIUTORT-GONZALEZ, ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
Last Name:RIUTORT-GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 CALLE WILSON
Mailing Address - Street 2:WILSON MEDICAL BLDG. OFFICE 2-A
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-2357
Mailing Address - Country:US
Mailing Address - Phone:787-728-4957
Mailing Address - Fax:787-728-1635
Practice Address - Street 1:1475 CALLE WILSON
Practice Address - Street 2:WILSON MEDICAL BLDG. OFFICE 2-A
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-2357
Practice Address - Country:US
Practice Address - Phone:787-728-4957
Practice Address - Fax:787-728-1635
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5427174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE31472Medicare UPIN