Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | 16139 | PR |
N | 207PP0204X | Pediatric Emergency Physician | 16139 | PR |
N | 208D00000X | General Practice Physician | 16139 | PR |
Y | 208D00000X | General Practice Physician | ACN918 | FL |
NPI | 1154372555 |
---|---|
Provider Name | Dr. Luis Angel Rivera Quinones |
First Address | Homestead, FL 33032-8001 |
Second Address | New Port Richey, FL 34652-2536 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 18/08/2020 |