Provider Demographics
NPI:1588368773
Name:GRAULAU MEDINA, DAVID RAFAEL
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:RAFAEL
Last Name:GRAULAU MEDINA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:469 AVE ESMERALDA, COND PLAZA ESMERALDA
Mailing Address - Street 2:APT 122
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4282
Mailing Address - Country:US
Mailing Address - Phone:787-503-6663
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF PUERTO RICO MEDICAL SCIENCES CAMPUS
Practice Address - Street 2:SCHOOL OF MEDICINE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936-5067
Practice Address - Country:US
Practice Address - Phone:787-763-1824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program