Healthcare Provider Details

I. General information

NPI: 1932213691
Provider Name (Legal Business Name): ENRIQUE A. RIVERA LUGO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

D1 CALLE BALDORIOTY URB. PARADIS
CAGUAS PR
00725-2655
US

IV. Provider business mailing address

PO BOX 1176
CAGUAS PR
00726-1176
US

V. Phone/Fax

Practice location:
  • Phone: 787-746-4843
  • Fax: 787-258-0750
Mailing address:
  • Phone: 787-746-4843
  • Fax: 787-258-0750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number6703
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: