Provider Demographics
NPI:1821794207
Name:CALVOS, RAFAEL CARLOS I
Entity Type:Individual
Prefix:MR
First Name:RAFAEL
Middle Name:CARLOS
Last Name:CALVOS
Suffix:I
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:RAFAEL
Other - Middle Name:CARLOS
Other - Last Name:CALVOS
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11916 SW 123RD PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5059
Mailing Address - Country:US
Mailing Address - Phone:786-867-1436
Mailing Address - Fax:305-418-0609
Practice Address - Street 1:19816 SW 123RD PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-4959
Practice Address - Country:US
Practice Address - Phone:786-867-1436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-137615106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician