Provider Demographics
NPI:1003413931
Name:NIEVES RIVERA, LUIS JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:JOSE
Last Name:NIEVES RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 970
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-0970
Mailing Address - Country:US
Mailing Address - Phone:787-881-9788
Mailing Address - Fax:
Practice Address - Street 1:CARR #2 KM 65.6 BO FACTOR 1
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-881-9788
Practice Address - Fax:787-817-1878
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR529-P.A.363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant