Provider Demographics
NPI:1427243310
Name:BAEZ-BONILLA, RAFAEL J (MD)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:J
Last Name:BAEZ-BONILLA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 E COMMERCIAL BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3747
Mailing Address - Country:US
Mailing Address - Phone:954-570-1757
Mailing Address - Fax:954-595-2163
Practice Address - Street 1:1880 E COMMERCIAL BLVD STE 4
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3747
Practice Address - Country:US
Practice Address - Phone:954-570-1757
Practice Address - Fax:954-595-2163
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME116500207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHN605ZMedicare PIN