Provider Demographics
NPI:1285900811
Name:R.E.P MEDICAL SERV, CSP
Entity type:Organization
Organization Name:R.E.P MEDICAL SERV, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ESPINET PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-841-2878
Mailing Address - Street 1:2864 CALLE HIBISCUS
Mailing Address - Street 2:URB VILLA FLORES
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2914
Mailing Address - Country:US
Mailing Address - Phone:787-841-2878
Mailing Address - Fax:787-841-2888
Practice Address - Street 1:2864 CALLE HIBISCUS
Practice Address - Street 2:URB VILLA FLORES
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2914
Practice Address - Country:US
Practice Address - Phone:787-841-2878
Practice Address - Fax:787-841-2888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0016772207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0028628Medicare PIN