Provider Demographics
NPI:1922081512
Name:RAMIREZ, RAFAEL (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:RAMIREZ
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 1:11924 BALM RIVERVIEW ROAD
Mailing Address - Street 2:HILLSBOROUGH
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569
Mailing Address - Country:US
Mailing Address - Phone:787-447-8989
Mailing Address - Fax:787-545-2723
Practice Address - Street 1:11924 BALM RIVERVIEW ROAD
Practice Address - Street 2:HILLSBOROUGH
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-3356
Practice Address - Country:US
Practice Address - Phone:813-717-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14564207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH80390Medicare UPIN
PR0021416Medicare PIN