Provider Demographics
NPI:1346284544
Name:PEREZ MOLINA, RAFAEL
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:PEREZ MOLINA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ANGEL
Other - Middle Name:LIFE
Other - Last Name:AMBULANCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 951
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-0951
Mailing Address - Country:US
Mailing Address - Phone:939-645-6744
Mailing Address - Fax:787-820-7500
Practice Address - Street 1:CARR NUM 2 KM 84.7 BO CARRIZALES
Practice Address - Street 2:URB ALTURAS CALLE JARDIN STE 3
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-0000
Practice Address - Country:US
Practice Address - Phone:939-645-6744
Practice Address - Fax:787-820-7500
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTCAMB 4063416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR57983ANOtherSSS REFORMA
PR50886OtherPMC
PR890775OtherMMM
PR890775OtherMMM