Basic Information
Provider Information | |||||||||
NPI: | 1396185831 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ARIAS BERRIOS | ||||||||
FirstName: | RAFAEL | ||||||||
MiddleName: | EDUARDO | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | CONDOMINIO TORRE DEL CARDENAL | ||||||||
Address2: | 675 CALLE S CUEVAS SPH 16 | ||||||||
City: | SAN JUAN | ||||||||
State: | PR | ||||||||
PostalCode: | 00918 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7877402270 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | INSTITUTO SAN PABLO SUITE 309 | ||||||||
Address2: | 66 CALLE SANTA CRUZ | ||||||||
City: | BAYAMON | ||||||||
State: | PR | ||||||||
PostalCode: | 009617049 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7877402270 | ||||||||
FaxNumber: | 7877404370 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/28/2013 | ||||||||
LastUpdateDate: | 02/06/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P2900X | 21070 | PR | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | 390200000X |   |   | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   | 208VP0000X | 21070 | PR | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.