Provider Demographics
NPI:1700915436
Name:RENDON, RAFAEL O (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:O
Last Name:RENDON
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 1:7 PARQ INTERAMERICANA
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784-7333
Mailing Address - Country:US
Mailing Address - Phone:787-864-3087
Mailing Address - Fax:
Practice Address - Street 1:7 PARQ INTERAMERICANA
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-7333
Practice Address - Country:US
Practice Address - Phone:787-864-3087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8717208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics