Provider Demographics
NPI:1790439586
Name:MUSSEB-GIL, RAFAEL (MH19985)
Entity Type:Individual
Prefix:MR
First Name:RAFAEL
Middle Name:
Last Name:MUSSEB-GIL
Suffix:
Gender:M
Credentials:MH19985
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 RICHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-3234
Mailing Address - Country:US
Mailing Address - Phone:321-278-1928
Mailing Address - Fax:
Practice Address - Street 1:965 RICHLAND AVE
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3234
Practice Address - Country:US
Practice Address - Phone:321-278-1928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH19985101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health