Provider Demographics
NPI:1508170101
Name:RIVERA, LUIS A
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:A
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 371050
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-1050
Mailing Address - Country:US
Mailing Address - Phone:787-636-3571
Mailing Address - Fax:
Practice Address - Street 1:CARR 1 KM 52.1
Practice Address - Street 2:BRISAS DE BEATRIZ
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00737-1050
Practice Address - Country:US
Practice Address - Phone:787-636-3571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-06
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17996261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care