Provider Demographics
NPI:1225487366
Name:DE LA GARZA RAMOS, RAFAEL (MD)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:DE LA GARZA RAMOS
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 1:3316 ROCHAMBEAU AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2841
Mailing Address - Country:US
Mailing Address - Phone:718-920-7400
Mailing Address - Fax:718-547-4591
Practice Address - Street 1:3316 ROCHAMBEAU AVE FL 3
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2841
Practice Address - Country:US
Practice Address - Phone:718-920-7400
Practice Address - Fax:718-547-4591
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY328606207T00000X
RIMD19037207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program