Provider Demographics
NPI:1740265164
Name:NOGUES, RAFAEL (MD)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:NOGUES
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 1:5775 BLUE LAGOON DR
Mailing Address - Street 2:SUITE 190
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2059
Mailing Address - Country:US
Mailing Address - Phone:305-442-0028
Mailing Address - Fax:305-476-1603
Practice Address - Street 1:5775 BLUE LAGOON DR
Practice Address - Street 2:SUITE 190
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2059
Practice Address - Country:US
Practice Address - Phone:305-442-0028
Practice Address - Fax:305-476-1603
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69090174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379058400Medicaid
FL28537Medicare ID - Type Unspecified
FL379058400Medicaid