Provider Demographics
NPI:1801415047
Name:RACC LLC
Entity Type:Organization
Organization Name:RACC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:COUTO CUERVO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-422-0004
Mailing Address - Street 1:59 CALLE KINGS CT APT 702
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00911-1166
Mailing Address - Country:US
Mailing Address - Phone:787-671-0416
Mailing Address - Fax:
Practice Address - Street 1:373 CALLE SAN JORGE STE 200
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912-3312
Practice Address - Country:US
Practice Address - Phone:787-422-0004
Practice Address - Fax:787-418-3106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-08
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty