MEDICARE: RAFAEL CRESPO FERNANDEZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	ACN 613	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194958603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAFAEL CRESPO FERNANDEZ MD

Provider Business Mailing Address
First Line	:	860 NW 42ND AVE
Second Line	:	FL 5
City	:	MIAMI
State	:	FL
Zip	:	33126
Country	:	US
Telephone Number	:	305-504-7885
Fax Number	:

Provider Business Practice Location Address
First Line	:	777 E 25TH ST STE 320
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-3849
Country	:	US
Telephone Number	:	305-302-0380
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2009
Last Update Date	:	03/16/2026

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