Healthcare Provider Details

I. General information

NPI: 1447923792
Provider Name (Legal Business Name): RAFAEL ROSALES PEREZ FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14285 SW 42ND ST STE 205
MIAMI FL
33175-6416
US

IV. Provider business mailing address

6100 BLUE LAGOON DR STE 365
MIAMI FL
33126-7010
US

V. Phone/Fax

Practice location:
  • Phone: 305-551-2165
  • Fax: 786-621-7812
Mailing address:
  • Phone: 786-322-7333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11014459
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: