Healthcare Provider Details

I. General information

NPI: 1124211735
Provider Name (Legal Business Name): RAFAEL E. PADRO PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 08/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 CARR 2 VILLA CAPARRA
GUAYNABO PR
00966-1915
US

IV. Provider business mailing address

239 CARR 2 VILLA CAPARRA
GUAYNABO PR
00966-1915
US

V. Phone/Fax

Practice location:
  • Phone: 787-792-8383
  • Fax: 787-792-8778
Mailing address:
  • Phone: 787-792-8383
  • Fax: 787-792-8778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number709
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: