Provider Demographics
NPI:1851319636
Name:HERNANDEZ, RAFAEL LACOMBA (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:LACOMBA
Last Name:HERNANDEZ
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 9020371
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00902-0371
Mailing Address - Country:US
Mailing Address - Phone:787-376-9091
Mailing Address - Fax:
Practice Address - Street 1:709 CALLE MIRAMAR
Practice Address - Street 2:SUITE #6
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00907-4109
Practice Address - Country:US
Practice Address - Phone:787-376-9091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8447208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice