Healthcare Provider Details

I. General information

NPI: 1801885249
Provider Name (Legal Business Name): DR. LUIS A RIVERA RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE COLON
AGUADA PR
00602-3166
US

IV. Provider business mailing address

PO BOX 3241
MAYAGUEZ PR
00681-3241
US

V. Phone/Fax

Practice location:
  • Phone: 787-868-7884
  • Fax: 787-252-8316
Mailing address:
  • Phone: 787-868-7884
  • Fax: 787-252-8316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number12911
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: