Healthcare Provider Details

I. General information

NPI: 1306813480
Provider Name (Legal Business Name): RAFAEL SENERIZ ORTIZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 11/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TORRE MEDICA SAN LUCAS OFICINA 507
PONCE PR
00716-0000
US

IV. Provider business mailing address

609 AVE TITO CASTRO PMB 386 SUITE 102
PONCE PR
00716-0200
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-7533
  • Fax: 787-812-7533
Mailing address:
  • Phone: 787-840-7533
  • Fax: 787-812-7533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number13536
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: