Provider Demographics
NPI:1457371817
Name:RIVERA, LOURDES (DPM)
Entity Type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3012
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-3012
Mailing Address - Country:US
Mailing Address - Phone:787-778-6676
Mailing Address - Fax:787-778-6676
Practice Address - Street 1:B12 CALLE SANTA CRUZ
Practice Address - Street 2:URB. SANTA CRUZ
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6902
Practice Address - Country:US
Practice Address - Phone:787-778-6676
Practice Address - Fax:787-778-6676
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRDPM098213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0060083Medicare PIN
PRU82218Medicare UPIN