Rafael Avecillas
Individual provider Active NPI Assisted Living Facility · Dover, FL
NPI 1194156489 · NPPES record last updated Dec 11, 2013
Key facts
- NPI
- 1194156489
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Assisted Living Facility 310400000X
- License
- AL11922 (FL)
- Practice address
- 2644 Fritzke Rd
Dover, FL 33527-3433 - Phone
- (813) 325-9450
- NPI assigned
- Dec 11, 2013
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AL11922 | FL | MD | Assisted Living Facility |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | AL11922 | FL | Yes |
Addresses
Primary practice location
2644 Fritzke Rd
Dover, FL 33527-3433
Mailing address
2644 Fritzke Rd
Dover, FL 33527-3433
Phone (813) 325-9450
Other providers in Dover, FL
All providers in Dover, FL · Assisted Living Facility in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 11, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.