Healthcare Provider Details

I. General information

NPI: 1073288593
Provider Name (Legal Business Name): MR. RAFAEL O VALLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6303 BLUE LAGOON DR STE 400
MIAMI FL
33126-6040
US

IV. Provider business mailing address

10416 N OKLAWAHA AVE
TAMPA FL
33617-3428
US

V. Phone/Fax

Practice location:
  • Phone: 561-235-7613
  • Fax:
Mailing address:
  • Phone: 786-474-0136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-26-2828027
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: