Healthcare Provider Details

I. General information

NPI: 1841227634
Provider Name (Legal Business Name): RAFAEL ANTONIO MUNNE QUINTANA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RAFAEL ANTONIO MUNNE MD

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 SE WALTON RD
PORT ST LUCIE FL
34952-7168
US

IV. Provider business mailing address

2318 NW BAY COLONY CT
STUART FL
34994-9129
US

V. Phone/Fax

Practice location:
  • Phone: 772-224-8928
  • Fax: 772-224-8229
Mailing address:
  • Phone: 772-323-4418
  • Fax: 772-934-6164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberME0071804
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: