Provider Demographics
NPI:1851454417
Name:SANJUAN, RAFAEL O
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:O
Last Name:SANJUAN
Suffix:
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 1:807 LANCASTER LN
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-8821
Mailing Address - Country:US
Mailing Address - Phone:757-877-5236
Mailing Address - Fax:
Practice Address - Street 1:MCDONALD ARMY HEALTH CENTER
Practice Address - Street 2:576 JEFFERSON AVE
Practice Address - City:FORT EUSTIS
Practice Address - State:VA
Practice Address - Zip Code:23604-5548
Practice Address - Country:US
Practice Address - Phone:757-314-7522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant