Provider Demographics
NPI:1386993244
Name:DR LUIS RAUL RUIZ RIVERA CSP
Entity type:Organization
Organization Name:DR LUIS RAUL RUIZ RIVERA CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDOCRINOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-848-4997
Mailing Address - Street 1:2614 CALLE MAYOR
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-2074
Mailing Address - Country:US
Mailing Address - Phone:787-848-4997
Mailing Address - Fax:787-848-4997
Practice Address - Street 1:2614 CALLE MAYOR
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2074
Practice Address - Country:US
Practice Address - Phone:787-848-4997
Practice Address - Fax:787-848-4997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6090207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0098735Medicare UPIN