Provider Demographics
NPI:1396913836
Name:IRIARTE, RAFAEL IVAN (MD)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:IVAN
Last Name:IRIARTE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 7004
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7004
Mailing Address - Country:US
Mailing Address - Phone:787-284-3618
Mailing Address - Fax:787-284-3619
Practice Address - Street 1:ANA DOLORES PEREZ MARCHAND STREET
Practice Address - Street 2:URBANIZACION INDUSTRIAL REPARADA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00732-7004
Practice Address - Country:US
Practice Address - Phone:787-284-3618
Practice Address - Fax:787-284-3619
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR6298207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine