Healthcare Provider Details

I. General information

NPI: 1477133650
Provider Name (Legal Business Name): LUIS CARLO RIVERA MARTINEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 09/28/2025
Certification Date: 09/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

982161 NEBRASKA MEDICAL CTR
OMAHA NE
68198-2161
US

IV. Provider business mailing address

982161 NEBRASKA MEDICAL CTR
OMAHA NE
68198-2161
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-5700
  • Fax:
Mailing address:
  • Phone: 402-955-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number10410
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: