Provider Demographics
NPI:1750475661
Name:AMARO, RAFAEL
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:
Last Name:AMARO
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 1:24003 FERNLAKE DR
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-1509
Mailing Address - Country:US
Mailing Address - Phone:310-994-7635
Mailing Address - Fax:
Practice Address - Street 1:24003 FERNLAKE DR
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-1509
Practice Address - Country:US
Practice Address - Phone:310-994-7635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG034264207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHJ849ZMedicare PIN
CAHJ849YMedicare PIN
CAA45852Medicare UPIN