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General NPI Number Information
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NPI Number | 1720192156
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Entity Type | Individual
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Provider Name | RAFAEL DEJESUS MOTA PA
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Gender | Male
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3940 W FLAGLER ST SUITE 201
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City | CORAL GABLES
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State | FL
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Zip | 33134-1613
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Country | US
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Telephone | 786-566-9900
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Fax | 305-266-0135
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Provider Business Mailing Address
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Address Line | 15483 SW 12 TERRACE
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City | MIAMI
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State | FL
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Zip | 33194
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Country | US
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Telephone | 305-266-0135
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Fax | 786-556-9900
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9100826
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License Number State | FL
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