1104915909 NPI number — MR. RAFAEL L MENDEZ-RODRIGUEZ MD

Table of content: MR. RAFAEL L MENDEZ-RODRIGUEZ MD (NPI 1104915909)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104915909 NPI number — MR. RAFAEL L MENDEZ-RODRIGUEZ MD

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
MENDEZ-RODRIGUEZ

Provider First Name:
RAFAEL

Provider Middle Name:
L

Provider Name Prefix Text:
MR.

Provider Name Suffix Text:

Provider Credential Text:
MD

Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:
MENDEZ-RODRIQUEZ

Provider Other First Name:
RAFAEL

Provider Other Middle Name:
L

Provider Other Name Prefix Text:
MR.

Provider Other Name Suffix Text:

Provider Other Credential Text:
MD

Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1104915909

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
12/13/2017

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3814

Provider Second Line Business Mailing Address:
AGUADILLA SHOPPING CENTER

Provider Business Mailing Address City Name:
AGUADILLA

Provider Business Mailing Address State Name:
PR

Provider Business Mailing Address Postal Code:
00605-3814

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
787-267-4620

Provider Business Mailing Address Fax Number:
787-267-4608

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 CALLE MATTEI LLUBERAS

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:
YAUCO

Provider Business Practice Location Address State Name:
PR

Provider Business Practice Location Address Postal Code:
00698-3814

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
787-267-4620

Provider Business Practice Location Address Fax Number:
787-267-4608

Provider Enumeration Date:
10/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

Provider Taxonomy Codes

Taxonomy code: 207VX0000X , with the licence number: 9856 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .