Provider Demographics
NPI:1265763510
Name:JACQUELINE VALDES-RAFULS, M.D., P.A.
Entity type:Organization
Organization Name:JACQUELINE VALDES-RAFULS, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDES-RAFULS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-273-7950
Mailing Address - Street 1:8000 SW 117TH AVE
Mailing Address - Street 2:SUITE #200
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4803
Mailing Address - Country:US
Mailing Address - Phone:305-273-7950
Mailing Address - Fax:305-273-7954
Practice Address - Street 1:8000 SW 117TH AVE
Practice Address - Street 2:SUITE #200
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4803
Practice Address - Country:US
Practice Address - Phone:305-273-7950
Practice Address - Fax:305-273-7954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPAX0000707363AM0700X
FLARNP2528362363LP0200X
FLME0062887208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373146400Medicaid
FL266167500Medicaid