Healthcare Provider Details

I. General information

NPI: 1255774725
Provider Name (Legal Business Name): RAFAEL A COUTO CUERVO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2013
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

373 CALLE SAN JORGE STE 200
SAN JUAN PR
00912-3312
US

IV. Provider business mailing address

373 CALLE SAN JORGE STE 200
SAN JUAN PR
00912-3312
US

V. Phone/Fax

Practice location:
  • Phone: 787-671-0416
  • Fax:
Mailing address:
  • Phone: 787-422-0004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberR9739
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number21271
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number35.131784
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: