Provider Demographics
NPI:1942269543
Name:CABALLERO-TORRES, RAFAEL (ENT)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:CABALLERO-TORRES
Suffix:
Gender:M
Credentials:ENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. REXMANOR CALLE 3-B8
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784
Mailing Address - Country:US
Mailing Address - Phone:787-864-0959
Mailing Address - Fax:787-866-0410
Practice Address - Street 1:AVE LOS VETERANOS ESQ CALLE 2 URB VILLA ROSA I
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-864-7101
Practice Address - Fax:787-866-0410
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8417174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE-43320Medicare UPIN
PR99613Medicare ID - Type Unspecified