Provider Demographics
NPI:1124074323
Name:RIVERA GONZALEZ, JUAN A (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:A
Last Name:RIVERA GONZALEZ
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:URB TERRANOBA ST 1 G1
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-708-2243
Mailing Address - Fax:787-708-2243
Practice Address - Street 1:UNIVERSITY PEDIATRIC HOSPITAL
Practice Address - Street 2:6TH FLOOR NEONATOLOGY SECTION
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00919-1079
Practice Address - Country:US
Practice Address - Phone:787-777-3225
Practice Address - Fax:787-758-5307
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2007-08-06
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-08-06
Provider Licenses
StateLicense IDTaxonomies
PR12398174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist