1811004336 NPI number — DR. LUIS ENRIQUE RIVERA I MD

Table of content: DR. LUIS ENRIQUE RIVERA I MD (NPI 1811004336)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811004336 NPI number — DR. LUIS ENRIQUE RIVERA I MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVERA
Provider First Name:
LUIS
Provider Middle Name:
ENRIQUE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
I
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1811004336
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
65 INFANTRY 174
Provider Second Line Business Mailing Address:
P.O. BOX 1065
Provider Business Mailing Address City Name:
VIEQUES
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00765-1065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-741-0738
Provider Business Mailing Address Fax Number:
787-741-0738

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
65 INFANTERIA 174
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VIEQUES
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00765-1065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-741-0738
Provider Business Practice Location Address Fax Number:
787-741-0738
Provider Enumeration Date:
08/23/2006

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: 173000000X , with the licence number:  12042 , 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: 1-12042 . This is a "MCS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 31-12042 . This is a "UIA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 400184 . This is a "MMM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 060670 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 87944RI . This is a "TRIPLE S, INC." identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 3264-I . This is a "PROSSAM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 765008 . This is a "HUMANA DE PR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 2011030 . This is a "PREFERRED HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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