MEDICARE: RAFAEL ANTONIO RODRIGUEZ SERRANO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	TCAMB663	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TCAMB663	OTHER	PR	SALUD

General Provider Information

NPI Number	:	1548563729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAFAEL ANTONIO RODRIGUEZ SERRANO

Provider Business Mailing Address
First Line	:	CARR #2 KM 94.2 INT, YEGUADA
Second Line	:
City	:	CAMUY
State	:	PR
Zip	:	00627-0000
Country	:	US
Telephone Number	:	787-458-2644
Fax Number	:

Provider Business Practice Location Address
First Line	:	CARR #2 KM 94.2 INT BO. YEGUADA
Second Line	:
City	:	CAMUY
State	:	PR
Zip	:	00627-0000
Country	:	US
Telephone Number	:	787-458-2644
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2010
Last Update Date	:	12/10/2010

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Directions to “ RAFAEL ANTONIO RODRIGUEZ SERRANO ” Practice Location

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