1164628194 NPI number — RAFAEL ACRA PA

Table of content: ASHLEY WHITMORE RELYEA PT (NPI 1831379346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164628194 NPI number — RAFAEL ACRA PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAFAEL ACRA PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164628194
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1949 S MIAMI AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33129-1514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-287-8790
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2990 CORAL WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-529-9295
Provider Business Practice Location Address Fax Number:
305-529-2551
Provider Enumeration Date:
06/26/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ACRA
Authorized Official First Name:
RAFAEL
Authorized Official Middle Name:
ANTONIO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
786-287-8790

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)