Provider Demographics
NPI:1699730911
Name:RIVERA ALLENDE, LUIS RAMON
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:RAMON
Last Name:RIVERA ALLENDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VIA 33 MN6 ESQUINA FIDALGO DIAZ VILLA FONTANA
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983
Mailing Address - Country:US
Mailing Address - Phone:787-768-8319
Mailing Address - Fax:787-768-8319
Practice Address - Street 1:VIA 33 MN6 ESQUINA FIDALGO DIAZ VILLA FONTANA
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-768-8319
Practice Address - Fax:787-768-8319
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR392111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR57027Medicare ID - Type UnspecifiedPROVIDER NUMBER
PRV-03813Medicare UPIN