Provider Demographics
NPI:1366918633
Name:RIVERA OTERO, LUIS DANIEL
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:DANIEL
Last Name:RIVERA OTERO
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:LUIS
Other - Middle Name:DANIEL
Other - Last Name:RIVERA OTERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 214
Mailing Address - Street 2:
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617-0214
Mailing Address - Country:US
Mailing Address - Phone:787-436-4279
Mailing Address - Fax:
Practice Address - Street 1:66 URB CATALANA
Practice Address - Street 2:
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617-2725
Practice Address - Country:US
Practice Address - Phone:787-421-8324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1036235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist