Healthcare Provider Details

I. General information

NPI: 1124506506
Provider Name (Legal Business Name): RAFAEL A PADRO AP, DOM, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2018
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 S DOUGLAS RD STE 301
CORAL GABLES FL
33134-6104
US

IV. Provider business mailing address

2550 S DOUGLAS RD STE 301
CORAL GABLES FL
33134-6104
US

V. Phone/Fax

Practice location:
  • Phone: 305-456-1014
  • Fax:
Mailing address:
  • Phone: 305-456-1014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number3974
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: