Provider Demographics
NPI:1427795434
Name:PRIMERA WEFFER, RAFAEL EDUARDO (SA-C)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:EDUARDO
Last Name:PRIMERA WEFFER
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13536 TURTLE MARSH LOOP APT 524
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-6621
Mailing Address - Country:US
Mailing Address - Phone:407-668-7195
Mailing Address - Fax:
Practice Address - Street 1:13536 TURTLE MARSH LOOP APT 524
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6621
Practice Address - Country:US
Practice Address - Phone:407-668-7195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18-149246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant