Healthcare Provider Details

I. General information

NPI: 1407051725
Provider Name (Legal Business Name): RAQUEL BOSCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. SANTA ANA 260 PLAZA ALTA MALL #4
BAYAMON PR
00960
US

IV. Provider business mailing address

AVE. SANTA ANA 260 PLAZA ALTA MALL #4
BAYAMON PR
00960
US

V. Phone/Fax

Practice location:
  • Phone: 787-708-6610
  • Fax:
Mailing address:
  • Phone: 787-708-6610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number26045 R
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: