Healthcare Provider Details

I. General information

NPI: 1376153536
Provider Name (Legal Business Name): HENRY ALEXANDER RUBERTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO MEDICO DE PUERTO RICO BARRIO MONACILLOS
SAN JUAN PR
00935-4816
US

IV. Provider business mailing address

PO BOX 60327
BAYAMON PR
00960-6032
US

V. Phone/Fax

Practice location:
  • Phone: 787-777-3535
  • Fax:
Mailing address:
  • Phone: 787-798-3001
  • Fax: 787-778-0460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number6189936
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number23813
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: