Healthcare Provider Details

I. General information

NPI: 1164625943
Provider Name (Legal Business Name): RAFAEL ERNESTO AZUAJE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 ALTON RD SUITE 470
MIAMI BEACH FL
33140-2891
US

IV. Provider business mailing address

6580 INDIAN CREEK DR APT. 605
MIAMI BEACH FL
33141-5891
US

V. Phone/Fax

Practice location:
  • Phone: 305-397-8236
  • Fax: 305-397-8889
Mailing address:
  • Phone: 305-397-8236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME86992
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: