Provider Demographics
NPI:1427188762
Name:RIVERA, LUIS B
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:B
Last Name:RIVERA
Suffix:
Gender:M
Credentials:
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 372
Mailing Address - Street 2:CALLE EULALIO REVERON 9
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-0372
Mailing Address - Country:US
Mailing Address - Phone:787-396-0736
Mailing Address - Fax:787-266-1105
Practice Address - Street 1:CALLE SATURNINO RODRIGUEZ
Practice Address - Street 2:#30
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767
Practice Address - Country:US
Practice Address - Phone:787-893-4455
Practice Address - Fax:787-893-3376
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3263183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist