MEDICARE: RACC LLC

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	2086S0122X	Plastic and Reconstructive Surgery Physician

General Provider Information

NPI Number	:	1801415047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RACC LLC

Provider Business Mailing Address
First Line	:	373 CALLE SAN JORGE STE 200
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00912-3312
Country	:	US
Telephone Number	:	787-422-0004
Fax Number	:

Provider Business Practice Location Address
First Line	:	373 CALLE SAN JORGE STE 200
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00912-3312
Country	:	US
Telephone Number	:	787-422-0004
Fax Number	:	787-418-3106

Authorized Official
Title or Position	:	OWNER
Name	:	RAFAEL A COUTO CUERVO
Credential	:	MD
Telephone Number	:	787-422-0004

Provider Enumeration Date	:	04/08/2020
Last Update Date	:	07/31/2024

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