Healthcare Provider Details

I. General information

NPI: 1093846875
Provider Name (Legal Business Name): LUIS A MARTINEZ-RIVERA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 04/19/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 AVE DONA FELISA RINCON DE STE 43 300 AVE DONA FELISA RINCON
SAN JUAN PR
00926-5970
US

IV. Provider business mailing address

AVE. FELISA RINCON #300 LAS VISTAS SHOPPING CENTER SUITE 43
SAN JUAN PR
00926-2805
US

V. Phone/Fax

Practice location:
  • Phone: 787-761-5880
  • Fax: 787-761-5880
Mailing address:
  • Phone: 787-761-5880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number16657
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: