Provider Demographics
NPI:1609800143
Name:FELIZ LEBREAULT, RAFAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:
Last Name:FELIZ LEBREAULT
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 4615
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-4615
Mailing Address - Country:US
Mailing Address - Phone:787-855-1385
Mailing Address - Fax:787-807-8912
Practice Address - Street 1:CARR. NUM. 2 KM 39.5
Practice Address - Street 2:SUITE 110
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-855-1385
Practice Address - Fax:787-807-8912
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4823207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR100197OtherMEDICARE MUCHO MAS ID#
PR212176OtherUTI
PR25874OtherSSS OF PUERTO RICO
PR25874OtherMEDICARE OPTIMO ID#
PR4823OtherCOSVI PROVIDER ID
PR1661OtherPEFERRED MEDICARE CHOICE
PR4823OtherIMC PROVIDER ID
PR6430019OtherHUMANA PORVIDER ID
PR063664OtherCRUZ AZUL DE PUERTO RICO
PR29825OtherAAMPR PROVIDER ID
PR3387OtherAMERICAN HEALTH PLAN
PR4304823OtherUIA
PR29825OtherAAMPR PROVIDER ID
PR4304823OtherUIA