Healthcare Provider Details

I. General information

NPI: 1649860651
Provider Name (Legal Business Name): KEVIN JOEL LUNA RIVERA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2021
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL MENONITA CAYEY
CAYEY PR
00736
US

IV. Provider business mailing address

HC 73 BOX 6019
CAYEY PR
00736-9512
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone: 787-612-0907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number024825
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: