Healthcare Provider Details

I. General information

NPI: 1811925548
Provider Name (Legal Business Name): RAFAEL GOSALBEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 SW 60TH CT STE 104
MIAMI FL
33155-4069
US

IV. Provider business mailing address

PO BOX 277279
ATLANTA GA
30384-7279
US

V. Phone/Fax

Practice location:
  • Phone: 305-669-6448
  • Fax: 305-663-8485
Mailing address:
  • Phone: 800-243-3839
  • Fax: 855-527-5510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberME63491
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: