Provider Demographics
NPI:1659529576
Name:FRIAS, RAFAEL A
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:A
Last Name:FRIAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2123 MARTIN LUTHER KING BOULEVARD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607
Mailing Address - Country:US
Mailing Address - Phone:813-873-2000
Mailing Address - Fax:
Practice Address - Street 1:2123 MARTIN LUTHER KING BOULEVARD
Practice Address - Street 2:SUITE 202
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607
Practice Address - Country:US
Practice Address - Phone:813-873-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL39166173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist