Provider Demographics
NPI:1871952515
Name:VALENZUELA-TAPIA, RAFAEL ELLIOT (DO, MD)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:ELLIOT
Last Name:VALENZUELA-TAPIA
Suffix:
Gender:M
Credentials:DO, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6349 LAS FLORES DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-2362
Mailing Address - Country:US
Mailing Address - Phone:516-439-0316
Mailing Address - Fax:
Practice Address - Street 1:5210 LINTON BLVD STE 105
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6537
Practice Address - Country:US
Practice Address - Phone:561-496-1160
Practice Address - Fax:561-496-2660
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2021-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS15718208D00000X, 207RN0300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program