| Doctor Name: | DR. LUIS ANGEL LOPEZRIVERA |
| NPI Number: | 1174713184 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 17506 |
| Business Practice Address: | 3189 Colonel Greg Malloy Rd Crestview, FL - 325396705 |
| Business Phone Number: | 8506834042 |
| Business Fax Number: | |
| Mailing Address: | 3116 Border Creek Rd, CRESTVIEW |
| State: | FL |
| Postal Code: | 325399060 |
| Phone Number: | 8503337575 |
| Fax Number: | |
| NPI Enumeration Date: | 07/26/2007 |
| NPI Last Update Date: | 02/11/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 17506 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | PR |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |