Provider Demographics
NPI:1972674935
Name:SANTOS SURIEL, RAFAEL A (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:A
Last Name:SANTOS SURIEL
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 1:83 UNION STREET
Mailing Address - Street 2:SUITE 129
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-3686
Mailing Address - Country:US
Mailing Address - Phone:787-844-6001
Mailing Address - Fax:
Practice Address - Street 1:83 UNION STREET
Practice Address - Street 2:SUITE 129
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-3686
Practice Address - Country:US
Practice Address - Phone:787-844-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR276156FX1800X
PR7242163WF0300X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Not Answered163WF0300XNursing Service ProvidersRegistered NurseFlight
Not Answered171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0028841Medicare ID - Type Unspecified
C77653Medicare UPIN