MEDICARE: MR. RAFAEL SALOMON II RAFAEL SALOMON

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	172V00000X	Community Health Worker	685650196	FL

General Provider Information

NPI Number	:	1497046692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAFAEL SALOMON II RAFAEL SALOMON

Provider Business Mailing Address
First Line	:	3184 W 72ND ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-5222
Country	:	US
Telephone Number	:	305-218-9479
Fax Number	:	305-364-9296

Provider Business Practice Location Address
First Line	:	3184 W 72ND ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-5222
Country	:	US
Telephone Number	:	305-218-9479
Fax Number	:	305-364-9296

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

Provider Enumeration Date	:	04/22/2011
Last Update Date	:	04/22/2011

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