MEDICARE: DR. LUIS RAUL RIVERO M.D., M.P.H.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	12919	PR
2	2083A0100X	Aerospace Medicine Physician	12919	PR

General Provider Information

NPI Number	:	1053382895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS RAUL RIVERO M.D., M.P.H.

Provider Business Mailing Address
First Line	:	PO BOX 105109
Second Line	:
City	:	FORT IRWIN
State	:	CA
Zip	:	92310-5109
Country	:	US
Telephone Number	:	760-383-5284
Fax Number	:

Provider Business Practice Location Address
First Line	:	WEED ARMY COMMUNITY HOSPITAL
Second Line	:	390 NORTH LOOP ROAD
City	:	FORT IRWIN
State	:	CA
Zip	:	92310-1507
Country	:	US
Telephone Number	:	760-383-5004
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	08/10/2021

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