Provider Demographics
NPI:1033593538
Name:RIVERA GONZALEZ, LUIS SANTIAGO (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:SANTIAGO
Last Name:RIVERA GONZALEZ
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 561040
Mailing Address - Street 2:
Mailing Address - City:GUAYANILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00656-3040
Mailing Address - Country:US
Mailing Address - Phone:787-605-2248
Mailing Address - Fax:
Practice Address - Street 1:9330 FL-54
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655
Practice Address - Country:US
Practice Address - Phone:727-834-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19837207P00000X
MO2018023743207P00000X
CAA153797207P00000X
TXR7581207P00000X
PR32761-R390200000X
PR33300-R390200000X
PR32049-R390200000X
FLME135275207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program