1881766467 NPI number — LUCIAN J RIVELA MD PA

Table of content: (NPI 1881766467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881766467 NPI number — LUCIAN J RIVELA MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUCIAN J RIVELA MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1881766467
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1442 KINGWOOD DRIVE
Provider Second Line Business Mailing Address:
PMB 73
Provider Business Mailing Address City Name:
KINGWOOD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-354-1234
Provider Business Mailing Address Fax Number:
281-354-2514

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9191 PINECROFT DR
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
THE WOODLANDS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-681-3905
Provider Business Practice Location Address Fax Number:
281-362-0403
Provider Enumeration Date:
11/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RIVELA
Authorized Official First Name:
LUCIAN
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
281-681-3905

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  K4991 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com