Healthcare Provider Details

I. General information

NPI: 1760444947
Provider Name (Legal Business Name): LUIS ANTONIO RIVERA NATALI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 CALLE ESTACION ESQUINA VIRGINIA
MAYAGUEZ PR
00680-3839
US

IV. Provider business mailing address

I - 4 CALLE JULIA DE BURGOS URBANIZACION BORINQUEN
CABO ROJO PR
00623-3351
US

V. Phone/Fax

Practice location:
  • Phone: 787-832-8444
  • Fax:
Mailing address:
  • Phone: 787-374-1515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number15938
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: