Provider Demographics
NPI:1346281094
Name:VALENZUELA, RAFAEL (MD,PHD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:
Last Name:VALENZUELA
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 NW 16TH ST
Mailing Address - Street 2:MIAMI HEALTH CARE SYSTEM (D-113)
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-1624
Mailing Address - Country:US
Mailing Address - Phone:305-575-3158
Mailing Address - Fax:305-575-3222
Practice Address - Street 1:1201 NW 16TH ST
Practice Address - Street 2:MIAMI HEALTH CARE SYSTEM (D-113)
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1624
Practice Address - Country:US
Practice Address - Phone:305-575-3158
Practice Address - Fax:305-575-3222
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 66024207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE65789Medicare UPIN