Healthcare Provider Details

I. General information

NPI: 1700848801
Provider Name (Legal Business Name): DAVID R RABAJA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5830 LAKE UNDERHILL RD
ORLANDO FL
32807-4311
US

IV. Provider business mailing address

15280 NW 79TH CT STE 200
MIAMI LAKES FL
33016-5873
US

V. Phone/Fax

Practice location:
  • Phone: 407-658-0228
  • Fax: 407-282-5483
Mailing address:
  • Phone: 305-558-3724
  • Fax: 786-907-4485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberOS0007924
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: