Healthcare Provider Details

I. General information

NPI: 1922133388
Provider Name (Legal Business Name): LUIS EDUARDO RIVERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: LUIS E RIVERA M.D.

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 E FRUIT ST SUITE 217
SANTA ANA CA
92701-4459
US

IV. Provider business mailing address

2220 E FRUIT ST SUITE 217
SANTA ANA CA
92701-4459
US

V. Phone/Fax

Practice location:
  • Phone: 714-560-0112
  • Fax: 714-560-0114
Mailing address:
  • Phone: 714-560-0112
  • Fax: 714-560-0114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA37834
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA37834
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberA37834
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA37834
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: