Provider Demographics
NPI:1295939312
Name:GONZALEZ RIVERA, ZAIDA I
Entity type:Individual
Prefix:MRS
First Name:ZAIDA
Middle Name:I
Last Name:GONZALEZ RIVERA
Suffix:
Gender:F
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 5 BOX 11195
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-9590
Mailing Address - Country:US
Mailing Address - Phone:787-312-9416
Mailing Address - Fax:
Practice Address - Street 1:CARR 568 KM 29.9
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783
Practice Address - Country:US
Practice Address - Phone:787-312-9416
Practice Address - Fax:787-854-1452
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4381104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRCZ254AMedicare PIN