MEDICARE: LUIS A PARIS RIVERA M.D

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	016071	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A704	OTHER	PR	INTERNATIONAL MEDICALCARD
2	016071	OTHER	PR	LICENSE PR

General Provider Information

NPI Number	:	1972579159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS A PARIS RIVERA M.D

Provider Business Mailing Address
First Line	:	BUILDING C#2, APARTMENT #42 SAN FERNANDO BAYAMON, PR.
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00917
Country	:	US
Telephone Number	:	787-786-4556
Fax Number	:	787-282-1058

Provider Business Practice Location Address
First Line	:	HF16 CALLE LIZZIE GRAHAM
Second Line	:	SEPTIMA SECCION LEVITTOWN
City	:	TOA BAJA
State	:	PR
Zip	:	00949-3634
Country	:	US
Telephone Number	:	787-200-2830
Fax Number	:	787-784-0680

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

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	07/06/2015

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