Provider Demographics
NPI:1568446532
Name:IGLESIAS, RAFAEL ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:ANTONIO
Last Name:IGLESIAS
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:PARQUE DE VILLA CAPARRO #21
Mailing Address - Street 2:CALLE ZUANIA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966
Mailing Address - Country:US
Mailing Address - Phone:787-354-5146
Mailing Address - Fax:787-792-9226
Practice Address - Street 1:CALLE CARAZO #44 SUITE 1C
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-724-0278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13327208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
I16159Medicare UPIN
0022408Medicare ID - Type Unspecified