1629059621 NPI number — DR. PEDRO RAFAEL ESACLONA M.D.

Employer Identification Number (EIN)	:
Provider Organization Name (Legal Business Name)	:
Provider Last Name (Legal Name)	:	ESACLONA
Provider First Name	:	PEDRO
Provider Middle Name	:	RAFAEL
Provider Name Prefix Text	:	DR.
Provider Name Suffix Text	:
Provider Credential Text	:	M.D.
Provider Gender Code	:	M

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Provider Other Last Name	:
Provider Other First Name	:
Provider Other Middle Name	:
Provider Other Name Prefix Text	:
Provider Other Name Suffix Text	:
Provider Other Credential Text	:
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NPI Number	:	1629059621
Entity Type Code	:	Individual
Replacement NPI	:
Last Update Date	:	07/08/2007
NPI Deactivation Reason Code	:
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Provider First Line Business Mailing Address	:	268 CALLE MIRAMAR
Provider Second Line Business Mailing Address	:
Provider Business Mailing Address City Name	:	MAYAGUEZ
Provider Business Mailing Address State Name	:	PR
Provider Business Mailing Address Postal Code	:	006825836
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	7872652250
Provider Business Mailing Address Fax Number	:

Provider First Line Business Practice Location Address	:	#416 CALLE BETANCES(POST)
Provider Second Line Business Practice Location Address	:
Provider Business Practice Location Address City Name	:	MAYAGUEZ
Provider Business Practice Location Address State Name	:	PR
Provider Business Practice Location Address Postal Code	:	00680
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	7872652250
Provider Business Practice Location Address Fax Number	:
Provider Enumeration Date	:	11/08/2005

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• Taxonomy code: 207Q00000X , with the licence number:  8122 , registered in the state of PR .

• Identifier: E09385 , issued by the state of ( PR ) . This identifiers is of the category "".
• Identifier: 0081345 , issued by the state of ( PR ) . This identifiers is of the category "".