Provider Demographics
NPI:1982798880
Name:RIEFKOHL, RICARDO ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:ANTONIO
Last Name:RIEFKOHL
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:PO BOX 12213
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00914-0213
Mailing Address - Country:US
Mailing Address - Phone:787-439-5326
Mailing Address - Fax:787-854-1452
Practice Address - Street 1:101-199 CALLE CORCHADO FINAL
Practice Address - Street 2:CLINICAS PM&R CDT CANOVANAS
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-0001
Practice Address - Country:US
Practice Address - Phone:939-439-6449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR166302081S0010X
NY258248208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRHO107AMedicare Oscar/Certification
NYA400054446Medicare PIN