Provider Demographics
NPI:1174507305
Name:RIVERA LOPEZ, LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:
Last Name:RIVERA LOPEZ
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 1503
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-1503
Mailing Address - Country:US
Mailing Address - Phone:787-856-5335
Mailing Address - Fax:787-856-5335
Practice Address - Street 1:CENTRO COMERCIAL BARINAS
Practice Address - Street 2:OFICINA #6
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-1503
Practice Address - Country:US
Practice Address - Phone:787-856-5335
Practice Address - Fax:787-856-5335
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5626208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics