Provider Demographics
NPI:1104915909
Name:MENDEZ-RODRIGUEZ, RAFAEL L (MD)
Entity type:Individual
Prefix:MR
First Name:RAFAEL
Middle Name:L
Last Name:MENDEZ-RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:RAFAEL
Other - Middle Name:L
Other - Last Name:MENDEZ-RODRIQUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3814
Mailing Address - Street 2:AGUADILLA SHOPPING CENTER
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-3814
Mailing Address - Country:US
Mailing Address - Phone:787-267-4620
Mailing Address - Fax:787-267-4608
Practice Address - Street 1:24 CALLE MATTEI LLUBERAS
Practice Address - Street 2:
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-3814
Practice Address - Country:US
Practice Address - Phone:787-267-4620
Practice Address - Fax:787-267-4608
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9856207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0088607Medicare ID - Type Unspecified
G41278Medicare UPIN