Provider Demographics
NPI:1205858107
Name:KALAF, NELSON RAFAEL (MD)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:RAFAEL
Last Name:KALAF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2023 E GRIFFIN PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3222
Mailing Address - Country:US
Mailing Address - Phone:956-585-2525
Mailing Address - Fax:
Practice Address - Street 1:2023 E GRIFFIN PKWY
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3222
Practice Address - Country:US
Practice Address - Phone:956-585-2525
Practice Address - Fax:956-585-0225
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL 0307207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092532305Medicaid
TX092532303Medicaid
TX8C8245Medicare ID - Type Unspecified