Provider Demographics
NPI:1043208895
Name:NUNEZ, RAFAEL O (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:O
Last Name:NUNEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3255 FOREST HILL BLVD
Mailing Address - Street 2:#103
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5854
Mailing Address - Country:US
Mailing Address - Phone:561-964-4577
Mailing Address - Fax:561-964-7772
Practice Address - Street 1:3255 FOREST HILL BLVD
Practice Address - Street 2:#103
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-6063
Practice Address - Country:US
Practice Address - Phone:561-964-4577
Practice Address - Fax:561-964-7772
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0076971207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255695200Medicaid
G85403Medicare UPIN
K2352Medicare ID - Type Unspecified