Provider Demographics
NPI:1376871863
Name:RAFAEL H ZARAGOZA URDAZ MD CSP
Entity Type:Organization
Organization Name:RAFAEL H ZARAGOZA URDAZ MD CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:ZARAGOZA URDAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:787-764-5715
Mailing Address - Street 1:317 AVE MANUEL DOMENECH
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3511
Mailing Address - Country:US
Mailing Address - Phone:787-764-5715
Mailing Address - Fax:787-764-3709
Practice Address - Street 1:317 AVE MANUEL DOMENECH
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3511
Practice Address - Country:US
Practice Address - Phone:787-764-5715
Practice Address - Fax:787-764-3709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2022-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRDA388AMedicare UPIN