Provider Demographics
NPI:1255405965
Name:LUIS E RIVERA MD INC
Entity type:Organization
Organization Name:LUIS E RIVERA MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:EDUARDO
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-751-9022
Mailing Address - Street 1:2222 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANNA
Mailing Address - State:CA
Mailing Address - Zip Code:92707
Mailing Address - Country:US
Mailing Address - Phone:714-751-9022
Mailing Address - Fax:714-751-9050
Practice Address - Street 1:2222 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTA ANNA
Practice Address - State:CA
Practice Address - Zip Code:92707
Practice Address - Country:US
Practice Address - Phone:714-751-9022
Practice Address - Fax:714-751-9050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A378340Medicare ID - Type Unspecified
A85056Medicare UPIN