Provider Demographics
NPI:1073589792
Name:JUSTINIANO, RAFAEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:A
Last Name:JUSTINIANO
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 1:714 CALLE AZORIN
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-6644
Mailing Address - Country:US
Mailing Address - Phone:787-834-4127
Mailing Address - Fax:
Practice Address - Street 1:CALLE MENDEZ VIGO 109 ESTE
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00681-3049
Practice Address - Country:US
Practice Address - Phone:787-834-7740
Practice Address - Fax:787-833-0868
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR49782086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR26944Medicare PIN
PRD99530Medicare UPIN