Provider Demographics
NPI:1730290396
Name:MIGUEL P. RIVERA, M.D. A.P.M.C.
Entity Type:Organization
Organization Name:MIGUEL P. RIVERA, M.D. A.P.M.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:PABLO
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-888-3292
Mailing Address - Street 1:3939 HOUMA BLVD
Mailing Address - Street 2:STE 216
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-6673
Mailing Address - Country:US
Mailing Address - Phone:504-888-3292
Mailing Address - Fax:504-888-3692
Practice Address - Street 1:3939 HOUMA BLVD
Practice Address - Street 2:STE 216
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-6673
Practice Address - Country:US
Practice Address - Phone:504-888-3292
Practice Address - Fax:504-888-3692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07271R261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5D653OtherMEDICARE
LACI3961OtherRAILROAD MEDICARE