Healthcare Provider Details

I. General information

NPI: 1609841824
Provider Name (Legal Business Name): JORGE RAFAEL RABAZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 SW 72ND ST STE 502
SOUTH MIAMI FL
33143-4830
US

IV. Provider business mailing address

PO BOX 198054
ATLANTA GA
30384-8054
US

V. Phone/Fax

Practice location:
  • Phone: 305-271-9777
  • Fax: 305-533-9450
Mailing address:
  • Phone: 305-271-9777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME0057346
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: