Provider Demographics
NPI:1396729406
Name:GONZALEZ-DE-RIVAS, MARIA DEL ROSARIO (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA DEL
Middle Name:ROSARIO
Last Name:GONZALEZ-DE-RIVAS
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:W7-11 BOSCAN ST., LADERAS PALMA REAL,
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-761-5662
Mailing Address - Fax:
Practice Address - Street 1:W7-11 BOSCAN ST., LADERAS PALMA REAL,
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-761-5662
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6856208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics