Provider Demographics
NPI:1881766467
Name:LUCIAN J RIVELA MD PA
Entity type:Organization
Organization Name:LUCIAN J RIVELA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUCIAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:RIVELA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-681-3905
Mailing Address - Street 1:1442 KINGWOOD DRIVE
Mailing Address - Street 2:PMB 73
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339
Mailing Address - Country:US
Mailing Address - Phone:281-354-1234
Mailing Address - Fax:281-354-2514
Practice Address - Street 1:9191 PINECROFT DR
Practice Address - Street 2:SUITE 150
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380
Practice Address - Country:US
Practice Address - Phone:281-681-3905
Practice Address - Fax:281-362-0403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4991208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00315VMedicare PIN