Provider Demographics
NPI:1831109545
Name:COLON-RIVAS, GLORIA MARIA (MD)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:MARIA
Last Name:COLON-RIVAS
Suffix:
Gender:F
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:URB. BAIROA
Mailing Address - Street 2:CALLE REINA ISABEL AB6
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-745-4665
Mailing Address - Fax:787-743-0177
Practice Address - Street 1:URB. BAIROA
Practice Address - Street 2:CALLE REINA ISABEL AB6
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-745-4665
Practice Address - Fax:787-743-0177
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12189207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG92464Medicare UPIN
G92464Medicare UPIN
PR90033Medicare PIN