Provider Demographics
NPI:1568453157
Name:MEDINA-RIVERA, RAFAEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:E
Last Name:MEDINA-RIVERA
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:URB CARMEN HILLS
Mailing Address - Street 2:5 VALLEY BLVD
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-8628
Mailing Address - Country:US
Mailing Address - Phone:787-287-0654
Mailing Address - Fax:787-735-7001
Practice Address - Street 1:RAMON FLORES #6
Practice Address - Street 2:
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:787-735-7001
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9995207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F25575Medicare UPIN
0082876Medicare ID - Type Unspecified