Healthcare Provider Details

I. General information

NPI: 1598867582
Provider Name (Legal Business Name): LUZ I RIVERA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 03/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CALLE CASIA
SAN JUAN PR
00921-3200
US

IV. Provider business mailing address

A14 CALLE DIANA SANTA ROSA
CAGUAS PR
00725-4676
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-7582
  • Fax: 787-641-8369
Mailing address:
  • Phone: 787-745-1213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number1089
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number9231214
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: