Provider Demographics
NPI:1194200725
Name:PARRA, RAFAEL IVAN (SA / C)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:IVAN
Last Name:PARRA
Suffix:
Gender:M
Credentials:SA / C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 N STANTON ST APT 11
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3566
Mailing Address - Country:US
Mailing Address - Phone:915-263-3715
Mailing Address - Fax:
Practice Address - Street 1:1707 N STANTON ST APT 11
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3566
Practice Address - Country:US
Practice Address - Phone:915-263-3715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-29
Last Update Date:2018-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18-381246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant