Provider Demographics
NPI:1982865663
Name:GONZALEZ RIVERA, HERIBERTO
Entity Type:Individual
Prefix:
First Name:HERIBERTO
Middle Name:
Last Name:GONZALEZ RIVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 3 BOX 7327
Mailing Address - Street 2:
Mailing Address - City:COMERIO
Mailing Address - State:PR
Mailing Address - Zip Code:00782-9612
Mailing Address - Country:US
Mailing Address - Phone:787-307-3615
Mailing Address - Fax:
Practice Address - Street 1:40 CALLE GEORGETTI
Practice Address - Street 2:ESQ. SANTIAGO R. PALMER
Practice Address - City:COMERIO
Practice Address - State:PR
Practice Address - Zip Code:00782-2537
Practice Address - Country:US
Practice Address - Phone:787-875-2121
Practice Address - Fax:787-875-2245
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001548183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician