Provider Demographics
NPI:1730266297
Name:RIVERA-CUBANO, LUIS (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:
Last Name:RIVERA-CUBANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CALLE WASHINGTON STE 4
Mailing Address - Street 2:CONDADO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1574
Mailing Address - Country:US
Mailing Address - Phone:787-722-3510
Mailing Address - Fax:787-722-4569
Practice Address - Street 1:30 CALLE WASHINGTON STE 4
Practice Address - Street 2:CONDADO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1574
Practice Address - Country:US
Practice Address - Phone:787-722-3510
Practice Address - Fax:787-722-4569
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5998146D00000X, 174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR97490Medicare ID - Type Unspecified