Provider Demographics
NPI:1639109671
Name:RAKHMANINA, IRINA E (MD)
Entity Type:Individual
Prefix:DR
First Name:IRINA
Middle Name:E
Last Name:RAKHMANINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10650 SW TRADITION PKWY
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2862
Mailing Address - Country:US
Mailing Address - Phone:772-241-6840
Mailing Address - Fax:
Practice Address - Street 1:10650 SW TRADITION PKWY
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2862
Practice Address - Country:US
Practice Address - Phone:772-241-6840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD56668207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD56668Medicaid
MDD56668OtherLICENSE