Provider Demographics
NPI:1548563729
Name:RODRIGUEZ SERRANO, RAFAEL ANTONIO
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:ANTONIO
Last Name:RODRIGUEZ SERRANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MEDICAL EXPRESS
Other - Middle Name:
Other - Last Name:AMBULANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:CARR #2 KM 94.2 INT, YEGUADA
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-0000
Mailing Address - Country:US
Mailing Address - Phone:787-458-2644
Mailing Address - Fax:
Practice Address - Street 1:CARR #2 KM 94.2 INT BO. YEGUADA
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-0000
Practice Address - Country:US
Practice Address - Phone:787-458-2644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTCAMB6633416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRTCAMB663OtherSALUD