Provider Demographics
NPI:1124107255
Name:OQUENDO, FRANCISCO RAFAEL (MD)
Entity type:Individual
Prefix:
First Name:FRANCISCO
Middle Name:RAFAEL
Last Name:OQUENDO
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 1:1140 S SEMORAN BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-1459
Mailing Address - Country:US
Mailing Address - Phone:407-384-9165
Mailing Address - Fax:407-384-9174
Practice Address - Street 1:1140 S SEMORAN BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-1459
Practice Address - Country:US
Practice Address - Phone:407-384-9165
Practice Address - Fax:407-384-9174
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15967208D00000X
FLACN598207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013950700Medicaid
FLHZ484ZMedicare PIN