Provider Demographics
NPI:1023166055
Name:ZARAGOZA URDAZ, RAFAEL H (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:H
Last Name:ZARAGOZA URDAZ
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 AVE MANUEL DOMENECH
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3511
Mailing Address - Country:US
Mailing Address - Phone:787-764-5715
Mailing Address - Fax:787-764-3709
Practice Address - Street 1:317 AVE MANUEL DOMENECH
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3511
Practice Address - Country:US
Practice Address - Phone:787-764-5715
Practice Address - Fax:787-764-3709
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2022-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11589207KA0200X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR84639OtherMEDICARE PROVIDER NUMBER
F27119Medicare UPIN