Provider Demographics
NPI:1740805191
Name:PAZ, RAFAEL E JR
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:E
Last Name:PAZ
Suffix:JR
Gender:M
Credentials:
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 86
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-0086
Mailing Address - Country:US
Mailing Address - Phone:787-880-3843
Mailing Address - Fax:787-880-3843
Practice Address - Street 1:CAR 129, INTERSECTION 490
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-880-3843
Practice Address - Fax:787-880-3843
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-11
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21904208D00000X
PR15108-I208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR21904Medicaid