Provider Demographics
NPI:1609093061
Name:LUZARDO, RAFAEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:R
Last Name:LUZARDO
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:PO BOX 9023558
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00902-3558
Mailing Address - Country:US
Mailing Address - Phone:787-725-4548
Mailing Address - Fax:787-721-0279
Practice Address - Street 1:1225 PONCE DE LEON AVE
Practice Address - Street 2:EFICIO VIG TOWER SUITE 702
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1772
Practice Address - Country:US
Practice Address - Phone:787-725-4548
Practice Address - Fax:877-777-3208
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10607208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR10607OtherSTATE LICENSE
PRDM-10096-6OtherPR DRUG STATE LICENSE
PRDM-10096-6OtherPR DRUG STATE LICENSE
PRBL-4757259OtherFEDERAL DRUG LICENSE
PRF53281Medicare UPIN