Provider Demographics
NPI:1497046692
Name:SALOMON, RAFAEL II (RAFAEL SALOMON)
Entity Type:Individual
Prefix:MR
First Name:RAFAEL
Middle Name:
Last Name:SALOMON
Suffix:II
Gender:M
Credentials:RAFAEL SALOMON
Other - Prefix:
Other - First Name:RAFAEL
Other - Middle Name:
Other - Last Name:SALOMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RAFAEL SALOMON
Mailing Address - Street 1:3184 W 72ND ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-5222
Mailing Address - Country:US
Mailing Address - Phone:305-218-9479
Mailing Address - Fax:305-364-9296
Practice Address - Street 1:3184 W 72ND ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-5222
Practice Address - Country:US
Practice Address - Phone:305-218-9479
Practice Address - Fax:305-364-9296
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL685650196172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker