Healthcare Provider Details

I. General information

NPI: 1265763510
Provider Name (Legal Business Name): JACQUELINE VALDES-RAFULS, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2010
Last Update Date: 02/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 SW 117TH AVE SUITE #200
MIAMI FL
33183-4803
US

IV. Provider business mailing address

8000 SW 117TH AVE SUITE #200
MIAMI FL
33183-4803
US

V. Phone/Fax

Practice location:
  • Phone: 305-273-7950
  • Fax: 305-273-7954
Mailing address:
  • Phone: 305-273-7950
  • Fax: 305-273-7954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0062887
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPAX0000707
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP2528362
License Number StateFL

VIII. Authorized Official

Name: MRS. JACQUELINE VALDES-RAFULS
Title or Position: DOCTOR
Credential: M.D.
Phone: 305-273-7950