Provider Demographics
NPI:1689744161
Name:MOLINA, RAFAEL J (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:J
Last Name:MOLINA
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 1:2475 BRICKELL AVE
Mailing Address - Street 2:UNIT 1107
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33129-2478
Mailing Address - Country:US
Mailing Address - Phone:305-335-8431
Mailing Address - Fax:
Practice Address - Street 1:2475 BRICKELL AVE
Practice Address - Street 2:UNIT 1107
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33129-2478
Practice Address - Country:US
Practice Address - Phone:305-335-8431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 00057422085U0001X
PR115422085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31641AOtherPTAN