Provider Demographics
NPI:1700037892
Name:UNDA-RIVERA, RAFAEL FRANCISCO (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:FRANCISCO
Last Name:UNDA-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:E4985 QUEENS DR
Mailing Address - Street 2:
Mailing Address - City:ELEVA
Mailing Address - State:WI
Mailing Address - Zip Code:54738-4143
Mailing Address - Country:US
Mailing Address - Phone:609-432-7508
Mailing Address - Fax:877-514-0903
Practice Address - Street 1:2116 CRAIG RD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6149
Practice Address - Country:US
Practice Address - Phone:715-858-4646
Practice Address - Fax:877-514-0903
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA142852207V00000X
WI67267-20207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology