1508924895 NPI number — LUZ I RIVERA PASTRANA PHD

Table of content: LUZ I RIVERA PASTRANA PHD (NPI 1508924895)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508924895 NPI number — LUZ I RIVERA PASTRANA PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVERA PASTRANA
Provider First Name:
LUZ
Provider Middle Name:
I
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508924895
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9437
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAYAMON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00960-9437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-486-2288
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
43-13 AVE MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00959-6501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-486-2288
Provider Business Practice Location Address Fax Number:
787-798-4492
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  1140 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: APS . This is a "2365" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: IMC . This is a "9952" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: HUMANA HEALTH PLANS . This is a "2091" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: LA CRUZ AZUL . This is a "10040" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: SSS . This is a "62995" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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