Provider Demographics
NPI:1801907233
Name:RUCABADO, TEODOSIO J (MD)
Entity type:Individual
Prefix:DR
First Name:TEODOSIO
Middle Name:J
Last Name:RUCABADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:73 CALLE MALVA
Mailing Address - Street 2:EXTENSION SANTA MARIA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6606
Mailing Address - Country:US
Mailing Address - Phone:787-764-3190
Mailing Address - Fax:787-766-1858
Practice Address - Street 1:405 CALLE DE DIEGO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-3012
Practice Address - Country:US
Practice Address - Phone:787-758-3506
Practice Address - Fax:787-766-1858
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR6410207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR978338Medicare PIN
PRD08751Medicare UPIN