Provider Demographics
NPI:1437387727
Name:DE COS, RAFAEL ANGEL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:ANGEL
Last Name:DE COS
Suffix:JR
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:J-2, D EAST ST. CIUDAD UNIVERSITARIA
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-3125
Mailing Address - Country:US
Mailing Address - Phone:787-960-9849
Mailing Address - Fax:
Practice Address - Street 1:J-2, D EAST ST. CIUDAD UNIVERSITARIA
Practice Address - Street 2:
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-3125
Practice Address - Country:US
Practice Address - Phone:787-960-9849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17600208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice