Provider Demographics
NPI:1801885249
Name:RIVERA RODRIGUEZ, LUIS A
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:A
Last Name:RIVERA RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3241
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-3241
Mailing Address - Country:US
Mailing Address - Phone:787-868-7884
Mailing Address - Fax:787-252-8316
Practice Address - Street 1:CALLE COLON
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-3166
Practice Address - Country:US
Practice Address - Phone:787-868-7884
Practice Address - Fax:787-252-8316
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12911207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG97128Medicare UPIN