Healthcare Provider Details

I. General information

NPI: 1417616632
Provider Name (Legal Business Name): RAFAEL CARTAYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8260 W FLAGLER ST STE 2I
MIAMI FL
33144-2069
US

IV. Provider business mailing address

8260 W FLAGLER ST STE 2I
MIAMI FL
33144-2069
US

V. Phone/Fax

Practice location:
  • Phone: 786-715-9183
  • Fax: 786-713-1115
Mailing address:
  • Phone: 786-715-9183
  • Fax: 786-713-1115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number022581
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1432
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: