Provider Demographics
NPI:1255764221
Name:RAEN MEDICAL SERVICES CORP
Entity type:Organization
Organization Name:RAEN MEDICAL SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYDEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ENCARNACION
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:305-477-9569
Mailing Address - Street 1:3900 NW 79TH AVE
Mailing Address - Street 2:SUITE 739
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6556
Mailing Address - Country:US
Mailing Address - Phone:305-477-9569
Mailing Address - Fax:305-477-9571
Practice Address - Street 1:3900 NW 79TH AVE
Practice Address - Street 2:SUITE 739
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6556
Practice Address - Country:US
Practice Address - Phone:305-477-9569
Practice Address - Fax:305-477-9571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-14
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC10750261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service