Healthcare Provider Details

I. General information

NPI: 1457336877
Provider Name (Legal Business Name): RAFAEL A PALMEROLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 W 49TH ST
HIALEAH FL
33012-3412
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 400
MIAMI FL
33126-2051
US

V. Phone/Fax

Practice location:
  • Phone: 305-274-9588
  • Fax: 305-595-2202
Mailing address:
  • Phone: 305-274-9588
  • Fax: 305-595-2202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME67254
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: