Healthcare Provider Details

I. General information

NPI: 1023166055
Provider Name (Legal Business Name): RAFAEL H ZARAGOZA URDAZ M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 12/10/2022
Certification Date: 12/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 AVE MANUEL DOMENECH
SAN JUAN PR
00918-3511
US

IV. Provider business mailing address

317 AVE MANUEL DOMENECH
SAN JUAN PR
00918-3511
US

V. Phone/Fax

Practice location:
  • Phone: 787-764-5715
  • Fax: 787-764-3709
Mailing address:
  • Phone: 787-764-5715
  • Fax: 787-764-3709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number11589
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: