Provider Demographics
NPI:1790719961
Name:RAUL F NODAL MDPA
Entity Type:Organization
Organization Name:RAUL F NODAL MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:F
Authorized Official - Last Name:NODAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-960-2142
Mailing Address - Street 1:11803 NICKLAUS CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-4539
Mailing Address - Country:US
Mailing Address - Phone:813-368-2160
Mailing Address - Fax:813-269-4109
Practice Address - Street 1:5012 GUNN HWY.
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624
Practice Address - Country:US
Practice Address - Phone:813-960-2142
Practice Address - Fax:813-269-4109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82531261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30391AMedicare ID - Type Unspecified
FLD53968Medicare UPIN