Healthcare Provider Details

I. General information

NPI: 1639173677
Provider Name (Legal Business Name): RAFAEL E VICENS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 CALLE RAFAEL ARROYO RIOS S
HUMACAO PR
00791-3932
US

IV. Provider business mailing address

PO BOX 9190
HUMACAO PR
00792-9190
US

V. Phone/Fax

Practice location:
  • Phone: 787-850-1695
  • Fax: 787-852-5185
Mailing address:
  • Phone: 787-850-1695
  • Fax: 787-852-5185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4675
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: