Provider Demographics
NPI:1184685091
Name:RODRIGUEZ-PAGAN, RAFAEL (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:RODRIGUEZ-PAGAN
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 61
Mailing Address - Street 2:
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660-0061
Mailing Address - Country:US
Mailing Address - Phone:787-264-3993
Mailing Address - Fax:787-264-3993
Practice Address - Street 1:CARR. 2 KM 174 BO CAIN BAJO
Practice Address - Street 2:SAN GERMAN MEDICAL PLAZA SUITE 214 BUZON 25715
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-264-3993
Practice Address - Fax:787-264-3993
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2020-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR134412084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0022710Medicare ID - Type Unspecified
PRI37053Medicare UPIN