Provider Demographics
NPI:1265559843
Name:CAMPOS LOPEZ, RAFAEL ADOLFO (MD)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:ADOLFO
Last Name:CAMPOS LOPEZ
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:PO BOX 3030
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-3030
Mailing Address - Country:US
Mailing Address - Phone:787-831-5479
Mailing Address - Fax:787-831-5479
Practice Address - Street 1:52 CALLE DE DIEGO W
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4733
Practice Address - Country:US
Practice Address - Phone:787-831-5479
Practice Address - Fax:787-831-5479
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15132208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR15132OtherSTATE
PRDM15028-4OtherAMSCA
PRDM15028-4OtherAMSCA
PRBC8543969OtherDEA
PRDM15028-4OtherAMSCA