MEDICARE: RAFAEL E VICENS 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	207V00000X	Obstetrics & Gynecology Physician	4675	PR

General Provider Information

NPI Number	:	1639173677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAFAEL E VICENS MD

Provider Business Mailing Address
First Line	:	PO BOX 9190
Second Line	:
City	:	HUMACAO
State	:	PR
Zip	:	00792-9190
Country	:	US
Telephone Number	:	787-850-1695
Fax Number	:	787-852-5185

Provider Business Practice Location Address
First Line	:	7 CALLE RAFAEL ARROYO RIOS S
Second Line	:
City	:	HUMACAO
State	:	PR
Zip	:	00791-3932
Country	:	US
Telephone Number	:	787-850-1695
Fax Number	:	787-852-5185

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	01/06/2011

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