Provider Demographics
NPI:1518066216
Name:RUIZ RIVERA, LUIS RAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:RAUL
Last Name:RUIZ RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2614 CALLE MAYOR
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-2075
Mailing Address - Country:US
Mailing Address - Phone:787-840-8293
Mailing Address - Fax:787-848-4997
Practice Address - Street 1:2614 CALLE MAYOR
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2075
Practice Address - Country:US
Practice Address - Phone:787-840-8293
Practice Address - Fax:787-848-4997
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6090174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD26734Medicare UPIN
PR98735Medicare ID - Type Unspecified