Provider Demographics
NPI:1477503696
Name:TRESPALACIOS, RAFAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:
Last Name:TRESPALACIOS
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 1:665 S APOLLO BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1485
Mailing Address - Country:US
Mailing Address - Phone:321-984-3200
Mailing Address - Fax:321-984-2620
Practice Address - Street 1:665 S APOLLO BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1485
Practice Address - Country:US
Practice Address - Phone:321-984-3200
Practice Address - Fax:321-984-2620
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061809A207W00000X
FLME98468207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278521800Medicaid
FL14672OtherBCBS OF FL
FLI56215Medicare UPIN
FL0539980004Medicare NSC
FLAD985ZMedicare PIN
FL14672OtherBCBS OF FL
FL278521800Medicaid
FLP00447494Medicare PIN
FL0539980003Medicare NSC