Healthcare Provider Details

I. General information

NPI: 1407816424
Provider Name (Legal Business Name): RAFAEL ENRIQUE ESPINOSA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 05/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MUNOZ RIVERA # 7
NAGUABO PR
00718
US

IV. Provider business mailing address

P.O BOX 8981
HUMACAO PR
00792
US

V. Phone/Fax

Practice location:
  • Phone: 787-874-3395
  • Fax: 787-874-3395
Mailing address:
  • Phone: 787-852-3756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number15701
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: