Provider Demographics
NPI:1841227634
Name:MUNNE QUINTANA, RAFAEL ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:ANTONIO
Last Name:MUNNE QUINTANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAFAEL
Other - Middle Name:ANTONIO
Other - Last Name:MUNNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2318 NW BAY COLONY CT
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-9129
Mailing Address - Country:US
Mailing Address - Phone:772-323-4418
Mailing Address - Fax:772-934-6164
Practice Address - Street 1:2550 SE WALTON RD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7168
Practice Address - Country:US
Practice Address - Phone:772-224-8928
Practice Address - Fax:772-224-8229
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00718042084A0401X, 2084P0800X
283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0071804OtherSTATE LICENSE