Provider Demographics
NPI:1427399641
Name:RIVERA, LUIS JOSE
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:JOSE
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 152
Mailing Address - Street 2:
Mailing Address - City:OROCOVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00720-0152
Mailing Address - Country:US
Mailing Address - Phone:787-867-2820
Mailing Address - Fax:787-867-2820
Practice Address - Street 1:6 CALLE PEDRO ARROYO
Practice Address - Street 2:
Practice Address - City:OROCOVIS
Practice Address - State:PR
Practice Address - Zip Code:00720-4422
Practice Address - Country:US
Practice Address - Phone:787-867-2820
Practice Address - Fax:787-867-2820
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9320183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician