Provider Demographics
NPI:1265697114
Name:VICENS RODRIGUEZ, RAFAEL ANDRES (MD)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:ANDRES
Last Name:VICENS RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9190
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-9190
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1710 CARR 2 # INT167
Practice Address - Street 2:CONDOMINIO GALLARDO TOWERS SUITE 101
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6329
Practice Address - Country:US
Practice Address - Phone:787-785-8034
Practice Address - Fax:787-787-8029
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR187312085B0100X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology