Provider Demographics
NPI:1932180593
Name:ARCHILLA ISERN, RAFAEL JAIME (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:JAIME
Last Name:ARCHILLA ISERN
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:PMB 261 200 AVE RAFAEL CORDERO
Mailing Address - Street 2:STE 140
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-3757
Mailing Address - Country:US
Mailing Address - Phone:787-743-2670
Mailing Address - Fax:787-743-2670
Practice Address - Street 1:AVE LUIS MUNOZ MARIN Y-24
Practice Address - Street 2:URB MARIOLGA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-743-2670
Practice Address - Fax:787-743-2670
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2011-01-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR7634208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
D08495Medicare UPIN