Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 19553 | PR |
NPI | 1003124728 |
---|---|
Provider Name | Rosbel Gonzalez Rivera |
First Address | Bayamon, PR 00961 |
Second Address | Bayamon, PR 00961 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2010 |
Last Update Date | 18/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
19553 | LICENSE (01) | PR |