Provider Demographics
NPI:1306813480
Name:SENERIZ ORTIZ, RAFAEL (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:SENERIZ ORTIZ
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 1:609 AVE TITO CASTRO
Mailing Address - Street 2:PMB 386 SUITE 102
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-0200
Mailing Address - Country:US
Mailing Address - Phone:787-840-7533
Mailing Address - Fax:787-812-7533
Practice Address - Street 1:TORRE MEDICA SAN LUCAS
Practice Address - Street 2:OFICINA 507
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-0000
Practice Address - Country:US
Practice Address - Phone:787-840-7533
Practice Address - Fax:787-812-7533
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR13536207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR20623OtherTRIPLE S INC
PR20623OtherTRIPLE S INC
PRH40336Medicare UPIN