Provider Demographics
NPI:1528363041
Name:RAPHA VASCULAR SPECIALISTS INC.
Entity Type:Organization
Organization Name:RAPHA VASCULAR SPECIALISTS INC.
Other - Org Name:CENTRAL FLORIDA VEIN INSTITUTE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OBINNA
Authorized Official - Middle Name:UCHENNA
Authorized Official - Last Name:NWOBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-689-8793
Mailing Address - Street 1:1619 HARDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-1826
Mailing Address - Country:US
Mailing Address - Phone:863-577-8346
Mailing Address - Fax:
Practice Address - Street 1:1619 HARDEN BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-1826
Practice Address - Country:US
Practice Address - Phone:863-577-8346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 1066332086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1912028853OtherNPI