Provider Demographics
NPI:1609841824
Name:RABAZA, JORGE RAFAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:RAFAEL
Last Name:RABAZA
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:PO BOX 198054
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8054
Mailing Address - Country:US
Mailing Address - Phone:305-271-9777
Mailing Address - Fax:
Practice Address - Street 1:6200 SW 72ND ST STE 502
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4830
Practice Address - Country:US
Practice Address - Phone:305-271-9777
Practice Address - Fax:305-533-9450
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0057346208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064757801Medicaid
FL11624WMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUM.