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General NPI Number Information
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NPI Number | 1366715633
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Entity Type | Individual
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Provider Name | RAFAEL ENRIQUE LIPORACI LUCENA MD
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Gender | Male
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Dates
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Enumeration Date | 02/17/2012
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Last Update Date | 07/14/2015
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Provider Practice Location Address
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Address Line | 174 ARMISTICE BLVD
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City | PAWTUCKET
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State | RI
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Zip | 02860-3280
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Country | US
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Telephone | 401-723-7578
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Fax |
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Provider Business Mailing Address
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Address Line | 3 REGENCY PLZ APT 709E
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City | PROVIDENCE
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State | RI
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Zip | 02903-3161
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Country | US
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Telephone | 917-297-0916
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD15059
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License Number State | RI
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