Provider Demographics
NPI:1174616577
Name:GONZALEZ, LETICIA RIVERA (MD)
Entity type:Individual
Prefix:MS
First Name:LETICIA
Middle Name:RIVERA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3050 CORLEAR AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463
Mailing Address - Country:US
Mailing Address - Phone:718-543-2700
Mailing Address - Fax:718-601-0965
Practice Address - Street 1:3050 CORLEAR AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463
Practice Address - Country:US
Practice Address - Phone:718-543-2700
Practice Address - Fax:718-601-0965
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2021-08-26
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Provider Licenses
StateLicense IDTaxonomies
NY185409207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01886704Medicaid
NY5030D1Medicare UPIN
NYF69293Medicare UPIN