Basic Information
| Provider Information | |||||||||
| NPI: | 1285984385 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RA MD SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3504 | ||||||||
| Address2: | |||||||||
| City: | JUNCOS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007776504 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 102 CALLE RAFAEL ALGARIN | ||||||||
| Address2: | URB VALENCIA I | ||||||||
| City: | JUNCOS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007773730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872077900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2012 | ||||||||
| LastUpdateDate: | 09/16/2012 | ||||||||
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| AuthorizedOfficialLastName: | RIVERA | ||||||||
| AuthorizedOfficialFirstName: | JOSE | ||||||||
| AuthorizedOfficialMiddleName: | ORLANDO | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7872077900 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.