Provider Demographics
NPI:1235117045
Name:MORETA, RAFAEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:A
Last Name:MORETA
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 778
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-0778
Mailing Address - Country:US
Mailing Address - Phone:787-872-0035
Mailing Address - Fax:787-872-0035
Practice Address - Street 1:ENSANCHEZ GONZALEZ #53
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-0778
Practice Address - Country:US
Practice Address - Phone:787-872-0035
Practice Address - Fax:787-872-0035
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8005174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist