Provider Demographics
NPI:1073533220
Name:RABELO, JOSE A
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:RABELO
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:A
Other - Last Name:RABELO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 864
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-0864
Mailing Address - Country:US
Mailing Address - Phone:787-263-1001
Mailing Address - Fax:
Practice Address - Street 1:SUITE 209 CATALINAS CINEMAS OFFICE CENTER
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-263-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10683207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR83609Medicare ID - Type Unspecified