Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 28917 | TX |
NPI | 1003258005 |
---|---|
Provider Name | Rafael F Carrales |
First Address | Edinburg, TX 78539-7003 |
Second Address | Edinburg, TX 78539-5514 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2013 |
Last Update Date | 19/07/2013 |