Provider Demographics
NPI:1407816424
Name:ESPINOSA, RAFAEL ENRIQUE (MD)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:ENRIQUE
Last Name:ESPINOSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O BOX 8981
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792
Mailing Address - Country:US
Mailing Address - Phone:787-852-3756
Mailing Address - Fax:
Practice Address - Street 1:MUNOZ RIVERA # 7
Practice Address - Street 2:
Practice Address - City:NAGUABO
Practice Address - State:PR
Practice Address - Zip Code:00718
Practice Address - Country:US
Practice Address - Phone:787-874-3395
Practice Address - Fax:787-874-3395
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15701207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRLIC 15701OtherA 0002- INTERNAL MEDICINE
PR2-3328Medicare ID - Type UnspecifiedA 0002
PRLIC 15701OtherA 0002- INTERNAL MEDICINE