Provider Demographics
NPI:1942299375
Name:MARTIN GARCIA, RAFAEL FEDERICO (MD)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:FEDERICO
Last Name:MARTIN GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 AVE ASHFORD
Mailing Address - Street 2:SUITE 611
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1511
Mailing Address - Country:US
Mailing Address - Phone:787-724-3407
Mailing Address - Fax:787-977-7876
Practice Address - Street 1:1451 AVE ASHFORD
Practice Address - Street 2:SUITE 611
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1511
Practice Address - Country:US
Practice Address - Phone:787-724-3407
Practice Address - Fax:787-977-7876
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10,707207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
82899Medicare ID - Type Unspecified
F27577Medicare UPIN