Provider Demographics
NPI:1639173677
Name:VICENS, RAFAEL E (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:E
Last Name:VICENS
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 9190
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-9190
Mailing Address - Country:US
Mailing Address - Phone:787-850-1695
Mailing Address - Fax:787-852-5185
Practice Address - Street 1:7 CALLE RAFAEL ARROYO RIOS S
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3932
Practice Address - Country:US
Practice Address - Phone:787-850-1695
Practice Address - Fax:787-852-5185
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4675207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR96342Medicare ID - Type Unspecified
E 31175Medicare UPIN