MEDICARE: DR. RAFAEL PICHARDO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	4479	PR

General Provider Information

NPI Number	:	1104803857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAFAEL PICHARDO MD

Provider Business Mailing Address
First Line	:	BOX 2129
Second Line	:	ADMINISTRACION DE SERVICIOS MEDICOS DE PR
City	:	SAN JUAN
State	:	PR
Zip	:	00926-3141
Country	:	US
Telephone Number	:	787-382-6241
Fax Number	:	787-251-4518

Provider Business Practice Location Address
First Line	:	1669 CALLE ORINOCO
Second Line	:	URB EL CEREZAL
City	:	SAN JUAN
State	:	PR
Zip	:	00926-3141
Country	:	US
Telephone Number	:	787-777-3535
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	07/08/2007

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