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General NPI Number Information
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NPI Number | 1538322474
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Entity Type | Individual
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Provider Name | RAUL OCTAVIANI MD
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Gender | Male
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Dates
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Enumeration Date | 07/09/2008
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Last Update Date | 09/26/2013
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Provider Practice Location Address
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Address Line | ST CASIA #10 VA MEDICAL CENTER
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City | SAN JUAN
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State | PR
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Zip | 00921-3200
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Country | US
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Telephone | 787-641-7582
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Fax |
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Provider Business Mailing Address
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Address Line | B23 CALLE ADAMS URB. PARKVILLE SUR
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City | GUAYNABO
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State | PR
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Zip | 00969-4404
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Country | US
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Telephone | 787-643-7843
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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 | 41716
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 005538
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License Number State | PR
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