Healthcare Provider Details

I. General information

NPI: 1942299375
Provider Name (Legal Business Name): RAFAEL FEDERICO MARTIN GARCIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 11/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 AVE ASHFORD SUITE 611
SAN JUAN PR
00907-1511
US

IV. Provider business mailing address

1451 AVE ASHFORD SUITE 611
SAN JUAN PR
00907-1511
US

V. Phone/Fax

Practice location:
  • Phone: 787-724-3407
  • Fax: 787-977-7876
Mailing address:
  • Phone: 787-724-3407
  • Fax: 787-977-7876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number10,707
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: