Provider Demographics
NPI:1912068990
Name:SANCHEZ GUERRA, RAFAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:
Last Name:SANCHEZ GUERRA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 SW 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7451
Mailing Address - Country:US
Mailing Address - Phone:786-280-9870
Mailing Address - Fax:
Practice Address - Street 1:19501 SW 27 AVE
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056
Practice Address - Country:US
Practice Address - Phone:305-622-7202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 2674152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084752600Medicaid
FL084752600Medicaid
FLU45986Medicare UPIN