Provider Demographics
NPI:1306875075
Name:RIVAS-CHACON, RAFAEL F (MD)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:F
Last Name:RIVAS-CHACON
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:PO BOX 431169
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33243-1169
Mailing Address - Country:US
Mailing Address - Phone:305-663-8585
Mailing Address - Fax:
Practice Address - Street 1:3200 SW 60TH CT STE 105
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4069
Practice Address - Country:US
Practice Address - Phone:305-663-8505
Practice Address - Fax:305-663-6878
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0048624207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061811000Medicaid
FL061811000Medicaid
FLG30951Medicare UPIN