Provider Demographics
NPI:1336837541
Name:RIVERA, LUIS EDUARDO (DPM)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:EDUARDO
Last Name:RIVERA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242 NW 137TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2330
Mailing Address - Country:US
Mailing Address - Phone:954-649-3573
Mailing Address - Fax:
Practice Address - Street 1:3410 W 84TH ST STE 100
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-4906
Practice Address - Country:US
Practice Address - Phone:954-649-3573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program