Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 4978 | PR |
NPI | 1073589792 |
---|---|
Provider Name | Dr. Rafael A Justiniano |
First Address | Mayaguez, PR 00682-6644 |
Second Address | Mayaguez, PR 00681-3049 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2006 |
Last Update Date | 17/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D99530 | (02) | PR |