Provider Demographics
NPI:1952310096
Name:RIVERA, LUZ J (OD)
Entity Type:Individual
Prefix:MRS
First Name:LUZ
Middle Name:J
Last Name:RIVERA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:894 VIA PALMASOLA
Mailing Address - Street 2:HACIENDA SAN JOSE
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-3085
Mailing Address - Country:US
Mailing Address - Phone:787-286-8491
Mailing Address - Fax:787-286-8730
Practice Address - Street 1:AVE RAFAEL CORDERO
Practice Address - Street 2:#301 WALMART VISION CENTER
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-286-8491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR365152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR215954OtherPREFERRED HEALTH PLAN
PR57704OtherSSS