Provider Demographics
NPI:1972579159
Name:PARIS RIVERA, LUIS A (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:A
Last Name:PARIS RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BUILDING C#2, APARTMENT #42 SAN FERNANDO BAYAMON, PR.
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00917
Mailing Address - Country:US
Mailing Address - Phone:787-786-4556
Mailing Address - Fax:787-282-1058
Practice Address - Street 1:HF16 CALLE LIZZIE GRAHAM
Practice Address - Street 2:SEPTIMA SECCION LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-3634
Practice Address - Country:US
Practice Address - Phone:787-200-2830
Practice Address - Fax:787-784-0680
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR016071208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRA704OtherINTERNATIONAL MEDICALCARD
PR016071OtherLICENSE PR
PREY072ZMedicare PIN