Healthcare Provider Details

I. General information

NPI: 1184685091
Provider Name (Legal Business Name): RAFAEL RODRIGUEZ-PAGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 02/22/2020
Certification Date: 02/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 2 KM 174 BO CAIN BAJO SAN GERMAN MEDICAL PLAZA SUITE 214 BUZON 25715
SAN GERMAN PR
00683
US

IV. Provider business mailing address

PO BOX 61
HORMIGUEROS PR
00660-0061
US

V. Phone/Fax

Practice location:
  • Phone: 787-264-3993
  • Fax: 787-264-3993
Mailing address:
  • Phone: 787-264-3993
  • Fax: 787-264-3993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number13441
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number13441
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: