Provider Demographics
NPI:1376500744
Name:LUIS A RIVES MD LLC
Entity Type:Organization
Organization Name:LUIS A RIVES MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:E
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-287-1493
Mailing Address - Street 1:2430 VANDERBILT BEACH RD STE 108-273
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-2654
Mailing Address - Country:US
Mailing Address - Phone:239-287-1493
Mailing Address - Fax:239-244-9357
Practice Address - Street 1:2430 VANDERBILT BEACH RD STE 108-273
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109
Practice Address - Country:US
Practice Address - Phone:239-287-1493
Practice Address - Fax:239-244-9357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME704362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDA5324OtherMEDICARE RAILROAD
FLR1SK1OtherFLORIDA BLUE GROUP NUMBER
FL261295000Medicaid
FLR1SK1OtherFLORIDA BLUE GROUP NUMBER
FLDA5324OtherMEDICARE RAILROAD