Provider Demographics
NPI:1578540191
Name:RIVERA RIVERA, LUIS D (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:D
Last Name:RIVERA RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:T10 CALLE 11
Mailing Address - Street 2:URB COLINAS VERDES
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-1932
Mailing Address - Country:US
Mailing Address - Phone:787-410-4325
Mailing Address - Fax:787-926-0365
Practice Address - Street 1:1153 AVE EMERITO ESTRADA RIVERA
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-896-4700
Practice Address - Fax:787-926-0365
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15534208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2080COtherPMC
PR22604RIOtherSSS
PR0022604Medicare ID - Type Unspecified
PR22604RIOtherSSS