Provider Demographics
NPI:1366434151
Name:RIVERA-RODRIGUEZ, GABRIEL (MD)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:RIVERA-RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GABRIEL
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4409 UTICA ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-6530
Mailing Address - Country:US
Mailing Address - Phone:504-457-3687
Mailing Address - Fax:504-620-0250
Practice Address - Street 1:1111 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE N511
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3151
Practice Address - Country:US
Practice Address - Phone:504-349-6301
Practice Address - Fax:504-349-6308
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10953R207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1946095OtherGROUP MEDICAID #
LA5F615OtherGROUP MEDICARE #
LA1437254984OtherGROUP NPI - NEW ORLEANS NEPHROLOGY
LA199318Medicaid
LA5U790Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #
LAC34132Medicare UPIN
LA1437254984OtherGROUP NPI - NEW ORLEANS NEPHROLOGY