Provider Demographics
NPI:1457882268
Name:RIVERA-RIVERA, GABRIEL ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:ANTONIO
Last Name:RIVERA-RIVERA
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 1176
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-1176
Mailing Address - Country:US
Mailing Address - Phone:787-379-6922
Mailing Address - Fax:
Practice Address - Street 1:153 AVE JOSE DE DIEGO
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4779
Practice Address - Country:US
Practice Address - Phone:787-379-6922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-23
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314280207Y00000X
PR23072207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology