Provider Demographics
NPI:1932769726
Name:MENDOZA GAROFALO, RAFAEL ALEJANDRO (MD)
Entity type:Individual
Prefix:MR
First Name:RAFAEL
Middle Name:ALEJANDRO
Last Name:MENDOZA GAROFALO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:RAFAEL
Other - Middle Name:ALEJANDRO
Other - Last Name:MENDOZE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1611 NW 12TH AVE
Mailing Address - Street 2:HOLTZ BUILDING, EAST TOWER 2169
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136
Mailing Address - Country:US
Mailing Address - Phone:512-545-3530
Mailing Address - Fax:
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:HOLTZ BUILDING, EAST TOWER 2169
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136
Practice Address - Country:US
Practice Address - Phone:512-545-3530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program