Provider Demographics
NPI:1114145604
Name:MIGUEZ-BALSEIRO, RAFAEL HIRAM (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:HIRAM
Last Name:MIGUEZ-BALSEIRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1701 CALLE SAN ESTEBAN
Mailing Address - Street 2:URB. SAN IGNACIO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6555
Mailing Address - Country:US
Mailing Address - Phone:787-758-5526
Mailing Address - Fax:787-758-0110
Practice Address - Street 1:A-7 DEGETAU AVE.
Practice Address - Street 2:URB. BONEVILLE TERRACE
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-746-5757
Practice Address - Fax:787-745-5757
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR57922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR066102OtherBLUE CROSS
PR0099069Medicare ID - Type Unspecified
PR99069MIOtherBLUE SHIELD