Provider Demographics
NPI:1508924895
Name:RIVERA PASTRANA, LUZ I (PHD)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:I
Last Name:RIVERA PASTRANA
Suffix:
Gender:F
Credentials:PHD
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 9437
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-9437
Mailing Address - Country:US
Mailing Address - Phone:787-486-2288
Mailing Address - Fax:
Practice Address - Street 1:43-13 AVE MAIN
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-6501
Practice Address - Country:US
Practice Address - Phone:787-486-2288
Practice Address - Fax:787-798-4492
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1140103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRAPSOther2365
PRIMCOther9952
PRHUMANA HEALTH PLANSOther2091
PRLA CRUZ AZULOther10040
PRSSSOther62995