Healthcare Provider Details

I. General information

NPI: 1124958285
Provider Name (Legal Business Name): RAFAEL ANTONIO REDONDO TAMAYO SA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7340 SW 120TH ST
PINECREST FL
33156-4661
US

IV. Provider business mailing address

7340 SW 120TH ST
PINECREST FL
33156-4661
US

V. Phone/Fax

Practice location:
  • Phone: 786-599-8903
  • Fax:
Mailing address:
  • Phone: 786-599-8903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number18-558
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: