Provider Demographics
NPI:1982135638
Name:RIVERA-ALVAREZ, GUSTAVO ALEXIS (MD)
Entity Type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:ALEXIS
Last Name:RIVERA-ALVAREZ
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 1:6532 NW 170TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4617
Mailing Address - Country:US
Mailing Address - Phone:787-516-5773
Mailing Address - Fax:
Practice Address - Street 1:6532 NW 170TH TER
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-4617
Practice Address - Country:US
Practice Address - Phone:787-516-5773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL156099208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice