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General NPI Number Information
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NPI Number | 1508051442
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Entity Type | Organization
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Legal Business Name | J. RAPHA MEDICAL, PA
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 01/07/2010
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Provider Practice Location Address
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Address Line | 618 13TH STREET
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City | SAINT CLOUD
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State | FL
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Zip | 34769
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Country | US
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Telephone | 407-556-3999
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Fax | 407-556-3933
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Provider Business Mailing Address
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Address Line | PO BOX 421203
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City | KISSIMMEE
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State | FL
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Zip | 34742-1203
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Country | US
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Telephone | 407-556-3999
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Fax | 407-847-8380
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Authorized Official
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Title or Position | OWNER
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Name | TANYA MEDINA
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Credential | MD
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Telephone | 407-556-3999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME84474
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License Number State | FL
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