Provider Demographics
NPI:1699710426
Name:PRIETO, RAFAEL LEONARDO (MD)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:LEONARDO
Last Name:PRIETO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:353 NEW SHACKLE ISLAND RD STE 148C
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2366
Mailing Address - Country:US
Mailing Address - Phone:615-972-1100
Mailing Address - Fax:615-537-4950
Practice Address - Street 1:3443 DICKERSON PIKE STE 730
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-2527
Practice Address - Country:US
Practice Address - Phone:615-972-1100
Practice Address - Fax:615-537-4950
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40917208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ005901Medicaid
TN103I253567Medicare PIN