Healthcare Provider Details

I. General information

NPI: 1609626480
Provider Name (Legal Business Name): MEMONA RAFIQ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 04/03/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001, KINGSLEY AVENUE HCA FLORIDA ORANGE PARK HOSPITAL
ORANGE PARK FL
32073
US

IV. Provider business mailing address

2001, KINGSLEY AVENUE HCA FLORIDA ORANGE PARK HOSPITAL
ORANGE PARK FL
32073
US

V. Phone/Fax

Practice location:
  • Phone: 904-639-2005
  • Fax:
Mailing address:
  • Phone: 904-639-2005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: