Provider Demographics
NPI:1710548193
Name:RIVERA GORDON, ARNALDO ANDRES
Entity type:Individual
Prefix:
First Name:ARNALDO
Middle Name:ANDRES
Last Name:RIVERA GORDON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 CALLE PROF AUGUSTO RODRIGUEZ STE 600
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-2275
Mailing Address - Country:US
Mailing Address - Phone:787-497-0800
Mailing Address - Fax:787-982-6464
Practice Address - Street 1:1503 CALLE PROF AUGUSTO RODRIGUEZ STE 600
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2275
Practice Address - Country:US
Practice Address - Phone:787-497-0800
Practice Address - Fax:787-982-6464
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR85597163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse