Provider Demographics
NPI:1902177280
Name:FAITH MEDICAL GROUP INC
Entity Type:Organization
Organization Name:FAITH MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEULOFEU
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:305-634-9742
Mailing Address - Street 1:1840 W 49 STREET
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012
Mailing Address - Country:US
Mailing Address - Phone:305-634-9742
Mailing Address - Fax:605-634-9744
Practice Address - Street 1:1840 W 49 STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012
Practice Address - Country:US
Practice Address - Phone:305-634-9742
Practice Address - Fax:605-634-9744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82456207Q00000X
FLPT14991225100000X
FLMA44576225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty