Provider Demographics
NPI:1639291487
Name:RODRIGUEZ RIVERA, LUIS ALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ALBERTO
Last Name:RODRIGUEZ 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:PO BOX 371029
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-1029
Mailing Address - Country:US
Mailing Address - Phone:787-406-1039
Mailing Address - Fax:787-687-5745
Practice Address - Street 1:HOSPITAL SANTA ROSA
Practice Address - Street 2:AVE LOS VETERANOS, CARR 3 KM 135.7
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00785
Practice Address - Country:US
Practice Address - Phone:787-864-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14759174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR21700ROOtherSSS
PR21700Medicare UPIN