Provider Demographics
NPI:1013002377
Name:RIVERA NAZARIO, LUIS B (DC)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:B
Last Name:RIVERA NAZARIO
Suffix:
Gender:M
Credentials:DC
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 1560
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-1560
Mailing Address - Country:US
Mailing Address - Phone:787-233-1001
Mailing Address - Fax:
Practice Address - Street 1:525 AVE FD ROOSEVELT
Practice Address - Street 2:LA TORRE DE PLAZA, SUITE 805
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-8001
Practice Address - Country:US
Practice Address - Phone:787-233-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR418111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor