Provider Demographics
NPI:1851130140
Name:DE FERIA, RAFAEL ALEJANDRO
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:ALEJANDRO
Last Name:DE FERIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14056 SW 51ST LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-5937
Mailing Address - Country:US
Mailing Address - Phone:786-310-8707
Mailing Address - Fax:
Practice Address - Street 1:3900 HOLLYWOOD BLVD STE PH-E
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6760
Practice Address - Country:US
Practice Address - Phone:954-822-4175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-342106106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician