Luis Angel Lopezrivera, M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

ACN390 Issued in FL

Practice address

3189 Colonel Greg Malloy Rd
Crestview, FL 32539-6705

Phone

(850) 683-4042

NPI assigned

Jul 26, 2007

Last updated

Feb 11, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1185408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392076800000",
    "number": "1174713184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3116 BORDER CREEK RD",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325399060",
            "telephone_number": "850-333-7575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3189 COLONEL GREG MALLOY RD",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325396705",
            "telephone_number": "850-683-4042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOPEZRIVERA",
        "first_name": "LUIS",
        "middle_name": "ANGEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-26",
        "last_updated": "2014-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "17506",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "ACN390",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007626400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Tracy Dawn Logsdon, CPNP
• Wanda Michelle Long, LCSW
• Kate R Lops, MD
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• J. Enrique Lujan, M.D.
• Mercedes Luke, PT
• Lunas Home NP LLC

• General Practice Physician in Crestview, FL
• Providers in Crestview, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.