Provider Demographics
NPI:1477133650
Name:RIVERA, LUIS CARLO
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:CARLO
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 1:1700 CALLE FEDERICO MONTILLA S APT 1508
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-3071
Mailing Address - Country:US
Mailing Address - Phone:787-478-6451
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL PEDIATRICO UNIVERSITARIO DR. ANTONIO ORTIZ
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936
Practice Address - Country:US
Practice Address - Phone:787-474-0333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR36479208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty