Provider Demographics
NPI:1922133388
Name:RIVERA, LUIS EDUARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:EDUARDO
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LUIS
Other - Middle Name:E
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2220 E FRUIT ST
Mailing Address - Street 2:SUITE 217
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-4459
Mailing Address - Country:US
Mailing Address - Phone:714-560-0112
Mailing Address - Fax:714-560-0114
Practice Address - Street 1:2220 E FRUIT ST
Practice Address - Street 2:SUITE 217
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4459
Practice Address - Country:US
Practice Address - Phone:714-560-0112
Practice Address - Fax:714-560-0114
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37834208600000X, 207QA0505X, 2083X0100X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA85056Medicare UPIN
A85056Medicare UPIN