Healthcare Provider Details

I. General information

NPI: 1164645255
Provider Name (Legal Business Name): RAFAEL LONGO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 11/02/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 CALLE ROCHESTER
SAN JUAN PR
00927-4812
US

IV. Provider business mailing address

911 CALLE ROCHESTER
SAN JUAN PR
00927-4812
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-1836
  • Fax: 787-754-4279
Mailing address:
  • Phone: 787-758-1836
  • Fax: 787-754-4279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number1319
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: