Provider Demographics
NPI:1356919799
Name:ESPEJO, RAFAEL FRANCISCO JR
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:FRANCISCO
Last Name:ESPEJO
Suffix:JR
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 1:5 OLIVE DR APT 15
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-5252
Mailing Address - Country:US
Mailing Address - Phone:786-308-6423
Mailing Address - Fax:
Practice Address - Street 1:5 OLIVE DR APT 15
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-5252
Practice Address - Country:US
Practice Address - Phone:786-308-6423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-13
Last Update Date:2023-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-171380106S00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician