Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | 19501 | PR |
Y | 208D00000X | General Practice Physician | ACN981 | FL |
NPI | 1003205519 |
---|---|
Provider Name | Rafael Perfecto |
First Address | Yauco, PR 00698-0232 |
Second Address | Winter Garden, FL 34787-0091 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2015 |
Last Update Date | 11/09/2020 |