Provider Demographics
NPI:1982623245
Name:RIVAS, LUIS ANTONIO (PHD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ANTONIO
Last Name:RIVAS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 AVE ARBOLOTE APT 29
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5503
Mailing Address - Country:US
Mailing Address - Phone:787-461-2604
Mailing Address - Fax:
Practice Address - Street 1:G32 CALLE LA SANTA
Practice Address - Street 2:COLINAS METROPOLITANAS
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5211
Practice Address - Country:US
Practice Address - Phone:787-461-2604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2016-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2432103TC0700X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical