Provider Demographics
NPI:1578708947
Name:RAFAEL J. FORNARIS, M.D., P.A.
Entity Type:Organization
Organization Name:RAFAEL J. FORNARIS, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FORNARIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-833-0389
Mailing Address - Street 1:863 CELESTIAL VW
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-4374
Mailing Address - Country:US
Mailing Address - Phone:210-833-0389
Mailing Address - Fax:
Practice Address - Street 1:863 CELESTIAL VW
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78260-4374
Practice Address - Country:US
Practice Address - Phone:210-833-0389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5165207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty