Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | AL4517 | FL |
Y | 2081S0010X | Sports Medicine | AL4517 | FL |
Y | 213ES0000X | Sports Medicine | AL4517 | FL |
NPI | 1851829618 |
---|---|
Provider Name | Raphael Patino |
First Address | Hollywood, FL 33021-4014 |
Second Address | Boca Raton, FL 33487-1345 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2017 |
Last Update Date | 24/05/2017 |