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General NPI Number Information
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NPI Number | 1619098159
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Entity Type | Individual
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Provider Name | ROMMEL LUBIANO RIVERA M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 110 S 20TH ST SUITE 206
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City | PHILADELPHIA
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State | PA
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Zip | 19103-4486
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Country | US
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Telephone | 610-892-0565
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Fax |
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Provider Business Mailing Address
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Address Line | 2084 N RIDLEY CREEK RD
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City | MEDIA
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State | PA
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Zip | 19063-4531
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Country | US
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Telephone | 610-892-0565
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD 060112L
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License Number State | PA
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