Basic Information
Provider Information
NPI: 1003017450
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RIVERA
FirstName: GASPAR
MiddleName: MUNIZ
NamePrefix:  
NameSuffix:  
Credential: MEDICINE DOCTOR MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 3092
Address2:  
City: AQUADILLA
State: PR
PostalCode: 006053092
CountryCode: US
TelephoneNumber: 7878825621
FaxNumber:  
Practice Location
Address1: CARR #110 KM 224 BO CEIB2 BAJA HC04
Address2:  
City: AQUADILLA
State: PR
PostalCode: 006039770
CountryCode: US
TelephoneNumber: 7878825621
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/31/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208D00000X003659PRY Allopathic & Osteopathic PhysiciansGeneral Practice 

No ID Information.


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