Provider Demographics
NPI:1407849565
Name:RIVELA, LUCIAN JOSEPH (MD)
Entity Type:Individual
Prefix:MR
First Name:LUCIAN
Middle Name:JOSEPH
Last Name:RIVELA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3007 WOODLAND HILLS DRIVE
Mailing Address - Street 2:PMB 73
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339
Mailing Address - Country:US
Mailing Address - Phone:281-354-1234
Mailing Address - Fax:281-354-2514
Practice Address - Street 1:9191 PINECROFT DRIVE
Practice Address - Street 2:STE 150
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380
Practice Address - Country:US
Practice Address - Phone:281-681-3905
Practice Address - Fax:281-362-0403
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2019-09-16
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Provider Licenses
StateLicense IDTaxonomies
TXK4991208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162775401Medicaid
TX162775401Medicaid
G67461Medicare UPIN