Healthcare Provider Details

I. General information

NPI: 1801415047
Provider Name (Legal Business Name): RACC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2020
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: 787-422-0004
  • Fax: 787-418-3106
Mailing address:
  • Phone: 787-422-0004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RAFAEL A COUTO CUERVO
Title or Position: OWNER
Credential: MD
Phone: 787-422-0004