Provider Demographics
NPI:1467565820
Name:RAFAEL A. MUNNE -QUINTANA MD PC
Entity Type:Organization
Organization Name:RAFAEL A. MUNNE -QUINTANA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MUNNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-224-8928
Mailing Address - Street 1:915 NE BANYAN TREE DR
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-6154
Mailing Address - Country:US
Mailing Address - Phone:772-224-8928
Mailing Address - Fax:772-224-8229
Practice Address - Street 1:915 NE BANYAN TREE DR
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-6154
Practice Address - Country:US
Practice Address - Phone:772-224-8928
Practice Address - Fax:772-224-8229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196991-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG18735Medicare UPIN