Provider Demographics
NPI:1245457936
Name:RAFFO, BERTHA M (MED)
Entity type:Individual
Prefix:MRS
First Name:BERTHA
Middle Name:M
Last Name:RAFFO
Suffix:
Gender:F
Credentials:MED
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Other - Credentials:
Mailing Address - Street 1:401 AVE AMERICO MIRANDA
Mailing Address - Street 2:COOP LOS ROBLES APT 401-B
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-4632
Mailing Address - Country:US
Mailing Address - Phone:787-754-0929
Mailing Address - Fax:
Practice Address - Street 1:550 CALLE SERGIO CUEVAS BUSTAMANTE
Practice Address - Street 2:HOSP MAESTRO CONSULTORIIO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-758-8383
Practice Address - Fax:787-767-6600
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR648103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist