Provider Demographics
NPI:1356010441
Name:RIVAS, LUIS MIGUEL
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:MIGUEL
Last Name:RIVAS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4203
Mailing Address - Country:US
Mailing Address - Phone:630-938-3300
Mailing Address - Fax:630-938-3310
Practice Address - Street 1:298 RANDALL RD
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4203
Practice Address - Country:US
Practice Address - Phone:630-938-3300
Practice Address - Fax:630-938-3310
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program