Provider Demographics
NPI:1134745466
Name:VINA, RAFAEL E
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:E
Last Name:VINA
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 1:6338 SW 42ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5112
Mailing Address - Country:US
Mailing Address - Phone:786-442-6226
Mailing Address - Fax:
Practice Address - Street 1:2460 SW 137TH AVE STE 242
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6399
Practice Address - Country:US
Practice Address - Phone:786-360-6496
Practice Address - Fax:786-534-3076
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-117946106S00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician