Healthcare Provider Details

I. General information

NPI: 1508095050
Provider Name (Legal Business Name): DR. RAFAEL A. PENALVER CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 07/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 NW 2ND STREET
MIAMI FL
33128-1205
US

IV. Provider business mailing address

971 NW 2ND ST
MIAMI FL
33128-1205
US

V. Phone/Fax

Practice location:
  • Phone: 305-545-7737
  • Fax: 305-545-5862
Mailing address:
  • Phone: 305-545-7737
  • Fax: 305-545-5862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. BORIS ALVAREZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 305-545-7737