Provider Demographics
NPI:1811004336
Name:RIVERA, LUIS ENRIQUE I (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ENRIQUE
Last Name:RIVERA
Suffix:I
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 1:65 INFANTRY 174
Mailing Address - Street 2:P.O. BOX 1065
Mailing Address - City:VIEQUES
Mailing Address - State:PR
Mailing Address - Zip Code:00765-1065
Mailing Address - Country:US
Mailing Address - Phone:787-741-0738
Mailing Address - Fax:787-741-0738
Practice Address - Street 1:65 INFANTERIA 174
Practice Address - Street 2:
Practice Address - City:VIEQUES
Practice Address - State:PR
Practice Address - Zip Code:00765-1065
Practice Address - Country:US
Practice Address - Phone:787-741-0738
Practice Address - Fax:787-741-0738
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12042173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1-12042OtherMCS
PR31-12042OtherUIA
PR400184OtherMMM
PR060670OtherCRUZ AZUL
PR87944RIOtherTRIPLE S, INC.
PR3264-IOtherPROSSAM
PR765008OtherHUMANA DE PR
PR2011030OtherPREFERRED HEALTH
PR3264-IOtherPROSSAM
PR765008OtherHUMANA DE PR