Provider Demographics
NPI:1033530829
Name:LUIS ADRIAN RIVERA POMALES, MD, MBA, MPH, CCD, DABBM, CSP
Entity Type:Organization
Organization Name:LUIS ADRIAN RIVERA POMALES, MD, MBA, MPH, CCD, DABBM, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:ADRIAN
Authorized Official - Last Name:RIVERA-POMALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MBA, MPH,
Authorized Official - Phone:707-312-8054
Mailing Address - Street 1:P.O. BOX 1059
Mailing Address - Street 2:
Mailing Address - City:ARROYO
Mailing Address - State:PR
Mailing Address - Zip Code:00714
Mailing Address - Country:US
Mailing Address - Phone:787-864-6570
Mailing Address - Fax:787-866-8298
Practice Address - Street 1:CALLE ASHFORD #62 NORTE
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-864-6570
Practice Address - Fax:787-866-8298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8309207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD08522Medicare UPIN