Provider Demographics
NPI:1225015894
Name:RIVERA-GUILBE, LUIS G (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:G
Last Name:RIVERA-GUILBE
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 2536
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-2536
Mailing Address - Country:US
Mailing Address - Phone:787-324-8144
Mailing Address - Fax:
Practice Address - Street 1:URB LA ARBOLEDA
Practice Address - Street 2:ROBLES STREET, NUM 13
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769
Practice Address - Country:US
Practice Address - Phone:787-837-6837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15673208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI 27860Medicare UPIN
PR0022897Medicare ID - Type Unspecified