Provider Demographics
NPI:1891858056
Name:MALDONADO-ROSA, RAFAEL (MD)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:MALDONADO-ROSA
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:PO BOX 1848
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-1848
Mailing Address - Country:US
Mailing Address - Phone:787-733-4474
Mailing Address - Fax:787-733-4474
Practice Address - Street 1:#21 JOSE C. BARBOSA
Practice Address - Street 2:
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771-1848
Practice Address - Country:US
Practice Address - Phone:787-733-4474
Practice Address - Fax:787-733-4474
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6818207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR066424OtherCRUZ AZUL PROVIDER NUMBER
PR2-8680OtherSSS PROVIDER NUMBER
PR066424OtherCRUZ AZUL PROVIDER NUMBER
PR2-8680OtherSSS PROVIDER NUMBER