Healthcare Provider Details

I. General information

NPI: 1023498599
Provider Name (Legal Business Name): RAFAEL GABRIEL FRIAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2015
Last Update Date: 02/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

871 PROSPECT AVE
BRONX NY
10459-3913
US

IV. Provider business mailing address

871 PROSPECT AVE
BRONX NY
10459-3913
US

V. Phone/Fax

Practice location:
  • Phone: 718-991-0605
  • Fax: 718-991-2391
Mailing address:
  • Phone: 718-991-0605
  • Fax: 718-991-2391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number289361
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: