Healthcare Provider Details

I. General information

NPI: 1255405965
Provider Name (Legal Business Name): LUIS E RIVERA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 S MAIN ST
SANTA ANNA CA
92707
US

IV. Provider business mailing address

2222 S MAIN ST
SANTA ANNA CA
92707
US

V. Phone/Fax

Practice location:
  • Phone: 714-751-9022
  • Fax: 714-751-9050
Mailing address:
  • Phone: 714-751-9022
  • Fax: 714-751-9050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LUIS EDUARDO RIVERA
Title or Position: PRESIDENT
Credential: MD
Phone: 714-751-9022