Provider Demographics
NPI:1194946145
Name:RUEDA, RAFAEL E (RPH)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:E
Last Name:RUEDA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 VALLE DEL TURABO
Mailing Address - Street 2:CAMPOS DE MONTEHIEDRA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-379-0168
Mailing Address - Fax:787-708-4669
Practice Address - Street 1:5 CALLE DIAZ NAVARRO
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-720-2626
Practice Address - Fax:787-708-4669
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4576183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist