Provider Demographics
NPI:1023073004
Name:GROVAS PORRATA, RAFAEL
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:GROVAS PORRATA
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:PO BOX 559
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-0559
Mailing Address - Country:US
Mailing Address - Phone:787-892-5030
Mailing Address - Fax:787-264-7279
Practice Address - Street 1:43 CALLE DR VEVE
Practice Address - Street 2:EDIFICIO GROVAS RODRIGUEZ SUITE 1
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-4100
Practice Address - Country:US
Practice Address - Phone:787-892-5030
Practice Address - Fax:787-264-7279
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12786174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR20624Medicare ID - Type Unspecified