Basic Information
| Provider Information | |||||||||
| NPI: | 1811925548 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOSALBEZ | ||||||||
| FirstName: | RAFAEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 277279 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303847279 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002433839 | ||||||||
| FaxNumber: | 8555275510 | ||||||||
| Practice Location | |||||||||
| Address1: | 3200 SW 60TH CT STE 104 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331554069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056696448 | ||||||||
| FaxNumber: | 3056638485 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 04/25/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2088P0231X | ME63491 | FL | Y | Allopathic & Osteopathic Physicians | Urology | Pediatric Urology |
ID Information
| ID | Type | State | Issuer | Description | 370961200 | 05 | FL | MEDICAID | 7911584 | 01 | FL | GHI | OTHER | 208048 | 01 | FL | AVMED | OTHER | 031838 | 01 | FL | NEIGHBORHOOD HEALTH PARTNERSHIP | OTHER | 148549 | 01 | FL | WELLCARE | OTHER | 17754 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER | 148549 | 01 | FL | STAYWELL | OTHER |