Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 418 | PR |
NPI | 1013002377 |
---|---|
Provider Name | Dr. Luis B Rivera |
First Address | Trujillo Alto, PR 00977-1560 |
Second Address | San Juan, PR 00918-8001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 08/07/2007 |