Provider Demographics
NPI:1215982244
Name:RIF MEDICAL GROUP, INC
Entity type:Organization
Organization Name:RIF MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAFAEL OTANO
Authorized Official - Middle Name:
Authorized Official - Last Name:OTANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-262-5457
Mailing Address - Street 1:815 NW 57TH AVE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2018
Mailing Address - Country:US
Mailing Address - Phone:305-262-5457
Mailing Address - Fax:305-262-5113
Practice Address - Street 1:815 NW 57TH AVE
Practice Address - Street 2:SUITE 114
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2018
Practice Address - Country:US
Practice Address - Phone:305-262-5457
Practice Address - Fax:305-262-5113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6377261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME 93274OtherTHEODORE T LAMOTTA
FL124792Medicare UPIN
FLK7738Medicare ID - Type UnspecifiedRIF MEDICAL GROUP, INC