Healthcare Provider Details

I. General information

NPI: 1316938194
Provider Name (Legal Business Name): RAFAEL JOSE ALBANDOZ JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CALLE GEORGETTI
SAN JUAN PR
00925-3505
US

IV. Provider business mailing address

26 CALLE 1 VILLA LOS OLMOS
SAN JUAN PR
00927-4605
US

V. Phone/Fax

Practice location:
  • Phone: 787-764-1830
  • Fax: 787-767-7741
Mailing address:
  • Phone: 787-764-6267
  • Fax: 787-764-6267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number6414
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: