Provider Demographics
NPI:1740302884
Name:ESTEVA, RAFAEL CLARENCE (6291MD)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:CLARENCE
Last Name:ESTEVA
Suffix:
Gender:M
Credentials:6291MD
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 875
Mailing Address - Street 2:
Mailing Address - City:LUQUILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00773-0875
Mailing Address - Country:US
Mailing Address - Phone:787-614-1077
Mailing Address - Fax:787-889-7001
Practice Address - Street 1:STREET 2 J6
Practice Address - Street 2:BRISAS DE MAR
Practice Address - City:LUQUILLO
Practice Address - State:PR
Practice Address - Zip Code:00773
Practice Address - Country:US
Practice Address - Phone:787-889-7001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6291261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health