Provider Demographics
NPI:1558742957
Name:RAFAEL BERRIOS MARCANO GINECOLOGO, P.S.C
Entity Type:Organization
Organization Name:RAFAEL BERRIOS MARCANO GINECOLOGO, P.S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPIETARIO
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRIOS MARCANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-787-1088
Mailing Address - Street 1:66 CALLE SANTA CRUZ
Mailing Address - Street 2:INSTITUTO SAN PABLO OFICINA 510
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-7041
Mailing Address - Country:US
Mailing Address - Phone:787-787-1088
Mailing Address - Fax:787-786-3398
Practice Address - Street 1:66 CALLE SANTA CRUZ
Practice Address - Street 2:INSTITUTO SAN PABLO OFICINA 510
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7041
Practice Address - Country:US
Practice Address - Phone:787-787-1088
Practice Address - Fax:787-786-3398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9426174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1861542243Other1861542243