Provider Demographics
NPI:1538322474
Name:OCTAVIANI, RAUL (MD)
Entity type:Individual
Prefix:DR
First Name:RAUL
Middle Name:
Last Name:OCTAVIANI
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:B23 CALLE ADAMS
Mailing Address - Street 2:URB. PARKVILLE SUR
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4404
Mailing Address - Country:US
Mailing Address - Phone:787-643-7843
Mailing Address - Fax:
Practice Address - Street 1:ST CASIA #10
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3200
Practice Address - Country:US
Practice Address - Phone:787-641-7582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL41716207R00000X
PR005538207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine