Healthcare Provider Details

I. General information

NPI: 1043662224
Provider Name (Legal Business Name): RAFAEL MIYASHIRO NUNES DOS SANTOS M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 NW 9TH AVE RM 329
MIAMI FL
33136
US

IV. Provider business mailing address

1801 NW 9TH AVE RM 329
MIAMI FL
33136-1101
US

V. Phone/Fax

Practice location:
  • Phone: 305-355-5760
  • Fax:
Mailing address:
  • Phone: 305-355-5760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License NumberME138668
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME138668
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: