Provider Demographics
NPI:1316984263
Name:AVILES, RAFAEL F (MD, PA)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:F
Last Name:AVILES
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2921 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2826
Mailing Address - Country:US
Mailing Address - Phone:305-642-2811
Mailing Address - Fax:305-642-1555
Practice Address - Street 1:2921 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2826
Practice Address - Country:US
Practice Address - Phone:305-642-2811
Practice Address - Fax:305-642-1555
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67736174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG00653Medicare UPIN