Provider Demographics
NPI:1700876257
Name:RIVERA-GOMEZ, ANGEL ANIBAL (MD)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:ANIBAL
Last Name:RIVERA-GOMEZ
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 1:554 CALLE ESTOCOLMO
Mailing Address - Street 2:CAPARRA HEIGHTS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920-4714
Mailing Address - Country:US
Mailing Address - Phone:787-782-0629
Mailing Address - Fax:
Practice Address - Street 1:CMS DR & COPPEOCH
Practice Address - Street 2:QUE BALBASA COC SICILIA 404
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00928
Practice Address - Country:US
Practice Address - Phone:787-764-7828
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5810208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice