Provider Demographics
NPI:1770586265
Name:GONZALEZ-RIVERA, HENRY (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
Last Name:GONZALEZ-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 1:130 AVE WINSTON CHURCHILL
Mailing Address - Street 2:SUITE 1 PMB 335
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6065
Mailing Address - Country:US
Mailing Address - Phone:787-765-1041
Mailing Address - Fax:787-765-6197
Practice Address - Street 1:200 AVE W CHURCHILL
Practice Address - Street 2:STE 201
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6652
Practice Address - Country:US
Practice Address - Phone:787-765-1041
Practice Address - Fax:787-765-6197
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12278207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0090340Medicare PIN
PRH90400Medicare UPIN
PR90340Medicare PIN