Healthcare Provider Details

I. General information

NPI: 1275530743
Provider Name (Legal Business Name): RAFAEL E RODRIGUEZ - LOPEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 09/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 AVE PONCE DE LEON TORRE MEDICA AUXILIO MUTUO SUITE 816
SAN JUAN PR
00918
US

IV. Provider business mailing address

735 AVE PONCE DE LEON TORRE MEDICA AUXILIO MUTUO SUITE 816
SAN JUAN PR
00918
US

V. Phone/Fax

Practice location:
  • Phone: 787-763-1025
  • Fax: 787-250-1928
Mailing address:
  • Phone: 787-763-1025
  • Fax: 787-250-1928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number7767
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: