Healthcare Provider Details

I. General information

NPI: 1205578564
Provider Name (Legal Business Name): MR. RAFAEL ENRIQUE GRAULAU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 04/08/2022
Certification Date: 03/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 CALLE JUAN C BORBON STE 77 DF02400-0
GUAYNABO PR
00969
US

IV. Provider business mailing address

469 AVE ESMERALDA COND PLAZA ESMERALDA APT 122
GUAYNABO PR
00969
US

V. Phone/Fax

Practice location:
  • Phone: 787-287-3725
  • Fax: 787-287-3711
Mailing address:
  • Phone: 787-307-5920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4988842
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: