Provider Demographics
NPI:1912236019
Name:RIVERA CRESPO, LUIS RAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:RAUL
Last Name:RIVERA CRESPO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525E LOHMAN AVE D
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-3394
Mailing Address - Country:US
Mailing Address - Phone:575-652-4426
Mailing Address - Fax:575-652-4426
Practice Address - Street 1:2801 E MISSOURI AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-5061
Practice Address - Country:US
Practice Address - Phone:575-521-8500
Practice Address - Fax:575-521-8400
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-18
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125053694207R00000X
NMMD2011-1053207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILR16053678259OtherDRIVER LICENSE