Provider Demographics
NPI:1790701704
Name:RIVERA GONZALEZ, RAFAEL M (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:M
Last Name:RIVERA 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:PO BOX 5489
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726
Mailing Address - Country:US
Mailing Address - Phone:787-751-5587
Mailing Address - Fax:787-753-4631
Practice Address - Street 1:AVE DE DIEGO 216 SEIN MEDICAL PLAZA
Practice Address - Street 2:REPARTO METROPOLITANO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-751-5587
Practice Address - Fax:787-753-4631
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR58112085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
E08257Medicare UPIN
27429Medicare ID - Type Unspecified