Provider Demographics
NPI:1104840404
Name:RIVERA, MIGUEL PABLO (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:PABLO
Last Name: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 1:3939 HOUMA BLVD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-6673
Mailing Address - Country:US
Mailing Address - Phone:504-888-3292
Mailing Address - Fax:504-888-3692
Practice Address - Street 1:3939 HOUMA BLVD
Practice Address - Street 2:SUITE 216
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-6673
Practice Address - Country:US
Practice Address - Phone:504-888-3292
Practice Address - Fax:504-888-3692
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07271R207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA110042235OtherRAILROAD MEDICARE
LA1377392Medicaid
LAD04247Medicare UPIN
LA54624Medicare ID - Type Unspecified