Provider Demographics
NPI:1063713345
Name:RIVERA GONZALEZ, KEREN (MD)
Entity type:Individual
Prefix:
First Name:KEREN
Middle Name:
Last Name:RIVERA GONZALEZ
Suffix:
Gender:F
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 3195
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-3195
Mailing Address - Country:US
Mailing Address - Phone:787-513-3791
Mailing Address - Fax:
Practice Address - Street 1:5J22 CALLE PARQUE BORINQUEN
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-3718
Practice Address - Country:US
Practice Address - Phone:787-513-3791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18086208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice