Provider Demographics
NPI:1942254610
Name:RIVERA VAZQUEZ, GISELA (MD)
Entity Type:Individual
Prefix:
First Name:GISELA
Middle Name:
Last Name:RIVERA VAZQUEZ
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:LOS LLANO CALLE 7 D27
Mailing Address - Street 2:SANTANA
Mailing Address - City:AREEIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612
Mailing Address - Country:US
Mailing Address - Phone:787-881-7544
Mailing Address - Fax:
Practice Address - Street 1:HATILLO CDT CSP #55
Practice Address - Street 2:CALLE FERNANDO VELAZQUEZ ESQUINA ROOSEVELT
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-820-9181
Practice Address - Fax:787-820-9181
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR#16193208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice