Basic Information
| Provider Information | |||||||||
| NPI: | 1700037892 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | UNDA-RIVERA | ||||||||
| FirstName: | RAFAEL | ||||||||
| MiddleName: | FRANCISCO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | E4985 QUEENS DR | ||||||||
| Address2: | |||||||||
| City: | ELEVA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 547384143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094327508 | ||||||||
| FaxNumber: | 8775140903 | ||||||||
| Practice Location | |||||||||
| Address1: | 2116 CRAIG RD | ||||||||
| Address2: | |||||||||
| City: | EAU CLAIRE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 547016149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7158584646 | ||||||||
| FaxNumber: | 8775140903 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2008 | ||||||||
| LastUpdateDate: | 10/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 142852 | CA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 67267-20 | WI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.