Healthcare Provider Details

I. General information

NPI: 1629140926
Provider Name (Legal Business Name): RAFAEL L OMS RIVERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 EDIF PARRA PONCE BY PASS SUITE 301
PONCE PR
00717-1321
US

IV. Provider business mailing address

2225 EDIF PARRA PONCE BY PASS SUITE 301
PONCE PR
00717-1321
US

V. Phone/Fax

Practice location:
  • Phone: 787-848-4937
  • Fax: 787-848-9289
Mailing address:
  • Phone: 787-848-4937
  • Fax: 787-848-9289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number8306
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: