MEDICARE: RAFAEL RODRIGUEZ RIOS 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	208D00000X	General Practice Physician	8111	PR

General Provider Information

NPI Number	:	1770574717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAFAEL RODRIGUEZ RIOS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 231
Second Line	:
City	:	CIALES
State	:	PR
Zip	:	00638-0231
Country	:	US
Telephone Number	:	787-871-3795
Fax Number	:	787-871-3795

Provider Business Practice Location Address
First Line	:	12 CALLE CORCHADO
Second Line	:
City	:	CIALES
State	:	PR
Zip	:	00638-3210
Country	:	US
Telephone Number	:	787-871-3795
Fax Number	:	787-871-3795

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

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	06/03/2010

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