Provider Demographics
NPI:1679806046
Name:WU RIVAS, LENA (MD)
Entity type:Individual
Prefix:
First Name:LENA
Middle Name:
Last Name:WU RIVAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1622 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-2776
Mailing Address - Country:US
Mailing Address - Phone:475-209-9130
Mailing Address - Fax:
Practice Address - Street 1:1622 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-2776
Practice Address - Country:US
Practice Address - Phone:475-209-9130
Practice Address - Fax:203-298-4380
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT051228207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine