Basic Information
| Provider Information | |||||||||
| NPI: | 1154372555 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIVERA QUINONES | ||||||||
| FirstName: | LUIS | ||||||||
| MiddleName: | ANGEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12171 SW 268TH ST | ||||||||
| Address2: | |||||||||
| City: | HOMESTEAD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330328001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052780200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5307 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | NEW PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346522536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7279007788 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 08/18/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | 16139 | PR | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services | 207PP0204X | 16139 | PR | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Pediatric Emergency Medicine | 208D00000X | 16139 | PR | N | Allopathic & Osteopathic Physicians | General Practice | 208D00000X | ACN918 | FL | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.