Individual
LUIS O. CUSTODIO RIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
VALLE VERDE CALLE ARBOLEDA 910, PONCE, PR 00716
(787) 512-1394
Mailing address
VALLE VERDE CALLE ARBOLEDA 910, PONCE, PR 00716
(787) 512-1394
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
06/12/2025
Last updated
06/12/2025
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