Provider Demographics
NPI:1619208089
Name:JUSTINIANO, RAFAEL JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:JOSE
Last Name:JUSTINIANO
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 1:335 CALLE VISTA BAHIA
Mailing Address - Street 2:CERRO LAS MESAS
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-8311
Mailing Address - Country:US
Mailing Address - Phone:787-832-4195
Mailing Address - Fax:787-831-4195
Practice Address - Street 1:335 CALLE VISTA BAHIA
Practice Address - Street 2:CERRO LAS MESAS
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-8311
Practice Address - Country:US
Practice Address - Phone:787-832-4195
Practice Address - Fax:787-831-4195
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-24
Last Update Date:2010-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17674208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice