Provider Demographics
NPI:1164833802
Name:MORENO-JACKSON, RAFINE (MD)
Entity type:Individual
Prefix:DR
First Name:RAFINE
Middle Name:
Last Name:MORENO-JACKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16082 SW 63RD TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-5576
Mailing Address - Country:US
Mailing Address - Phone:787-568-9065
Mailing Address - Fax:
Practice Address - Street 1:8720 N KENDALL DR STE 118
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2208
Practice Address - Country:US
Practice Address - Phone:305-686-9977
Practice Address - Fax:786-497-3226
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-15
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME141744207V00000X
LA329404207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2578014Medicaid
FL125123000Medicaid
LA329404OtherSTATE LICENSE