Provider Demographics
NPI:1497797294
Name:CORADIN RUIZ, RAFAEL IVAN (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:IVAN
Last Name:CORADIN RUIZ
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:CALLE FERNANDO DE ROJAS 2048
Mailing Address - Street 2:EL SENORIAL
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-266-4383
Mailing Address - Fax:
Practice Address - Street 1:CEUTRO SALUD FFANIELIAR DE GABUCOA
Practice Address - Street 2:CARRETERA 901
Practice Address - City:GABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767
Practice Address - Country:US
Practice Address - Phone:787-893-0480
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10906208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
G03005Medicare UPIN
PR89276Medicare ID - Type Unspecified