Provider Demographics
NPI:1508212879
Name:RIVERA GONZALEZ, JONATHAN L (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:L
Last Name:RIVERA GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:425 W COLONIAL DR STE 303
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6863
Mailing Address - Country:US
Mailing Address - Phone:210-630-2207
Mailing Address - Fax:407-271-8436
Practice Address - Street 1:900 S GOLDENROD RD STE B
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8113
Practice Address - Country:US
Practice Address - Phone:407-362-0148
Practice Address - Fax:407-271-8436
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2024-10-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR21828207R00000X, 208M00000X
FLME146934207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist