Provider Demographics
NPI:1215040530
Name:BAQUERO, RAFAEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:A
Last Name:BAQUERO
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 6628
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-6628
Mailing Address - Country:US
Mailing Address - Phone:787-746-7441
Mailing Address - Fax:787-746-3190
Practice Address - Street 1:AVE L MUNOZ MARIN
Practice Address - Street 2:OF 106 HIMA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-4081
Practice Address - Country:US
Practice Address - Phone:787-746-7441
Practice Address - Fax:787-746-3190
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4536207RN0300X
FLME 31992207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC79543Medicare UPIN
PR26512Medicare ID - Type Unspecified