MEDICARE: RAFAEL MIGUEL VAQUER M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program		PR
2	208100000X	Physical Medicine & Rehabilitation Physician	21219	PR

General Provider Information

NPI Number	:	1316492796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAFAEL MIGUEL VAQUER M.D.

Provider Business Mailing Address
First Line	:	100 GRAN BOULEVARD LOS PASEOS STE 112
Second Line	:	PMB 137
City	:	SAN JUAN
State	:	PR
Zip	:	00926-5595
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 GRAND PASEO BLVD
Second Line	:	PMB 137 STE. 112
City	:	SAN JUAN
State	:	PR
Zip	:	00926-5905
Country	:	US
Telephone Number	:	787-955-0828
Fax Number	:

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

Provider Enumeration Date	:	08/16/2016
Last Update Date	:	06/07/2022

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