Provider Demographics
NPI:1962439448
Name:RUIZ-QUIJANO, RAFAEL ANGEL
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:ANGEL
Last Name:RUIZ-QUIJANO
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:THE UPS STORE 2000
Mailing Address - Street 2:CARR. 8177 SUITE 26 PMB 202
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-3762
Mailing Address - Country:US
Mailing Address - Phone:787-780-6392
Mailing Address - Fax:787-780-6370
Practice Address - Street 1:BAYAMON MEDICAL PLZ
Practice Address - Street 2:SUITE 908
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-7200
Practice Address - Country:US
Practice Address - Phone:787-798-7751
Practice Address - Fax:787-780-6370
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5853208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE31233Medicare UPIN