1972579159 NPI number — LUIS A PARIS RIVERA M.D

Table of content: LUIS A PARIS RIVERA M.D (NPI 1972579159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972579159 NPI number — LUIS A PARIS RIVERA M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARIS RIVERA
Provider First Name:
LUIS
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D
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:
1972579159
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BUILDING C#2, APARTMENT #42 SAN FERNANDO BAYAMON, PR.
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:
00917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-786-4556
Provider Business Mailing Address Fax Number:
787-282-1058

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HF16 CALLE LIZZIE GRAHAM
Provider Second Line Business Practice Location Address:
SEPTIMA SECCION LEVITTOWN
Provider Business Practice Location Address City Name:
TOA BAJA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00949-3634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-200-2830
Provider Business Practice Location Address Fax Number:
787-784-0680
Provider Enumeration Date:
02/27/2006

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: 208D00000X , with the licence number:  016071 , 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: A704 . This is a "INTERNATIONAL MEDICALCARD" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 016071 . This is a "LICENSE PR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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