Healthcare Provider Details

I. General information

NPI: 1427898832
Provider Name (Legal Business Name): LUIS R SANTIAGO-RIVERA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2024
Last Update Date: 05/31/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARETERA 2 KM 56.6 BO FLORIDA AFUERA
BARCELONETA PR
00617
US

IV. Provider business mailing address

URB VISTA DE CAMUY CALLE 1 B 9
CAMUY PR
00627
US

V. Phone/Fax

Practice location:
  • Phone: 787-970-8105
  • Fax: 787-970-8115
Mailing address:
  • Phone: 787-442-4544
  • Fax: 787-970-8115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number372
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: