Provider Demographics
NPI:1174771067
Name:RIVERA, LUIS JOEL (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:JOEL
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LUIS
Other - Middle Name:JOEL
Other - Last Name:RIVERA RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:RR 18 BOX 661
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9718
Mailing Address - Country:US
Mailing Address - Phone:787-462-3218
Mailing Address - Fax:
Practice Address - Street 1:17 CALLE 2 STE 520
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-1750
Practice Address - Country:US
Practice Address - Phone:787-622-9797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR182352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR18235OtherLICENSE