Provider Demographics
NPI:1255774725
Name:COUTO CUERVO, RAFAEL A (MD)
Entity type:Individual
Prefix:MR
First Name:RAFAEL
Middle Name:A
Last Name:COUTO CUERVO
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 1:373 CALLE SAN JORGE STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00912-3312
Mailing Address - Country:US
Mailing Address - Phone:787-422-0004
Mailing Address - Fax:
Practice Address - Street 1:373 CALLE SAN JORGE STE 200
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912-3312
Practice Address - Country:US
Practice Address - Phone:787-671-0416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR97392086S0122X
PR212712086S0122X, 2086S0122X
OH35.131784208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0232410Medicaid