Balbino, Raphael Tito

Balbino, Raphael Tito is an individual health care provider with primary practice located at 841 Prudential Dr Ste 180 Attn: Credentialing Specialist, Jacksonville FL 32207-8350. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Geriatric Medicine. Allopathic & Osteopathic Physicians / Geriatric Medicine is his primary health care specialty. Balbino, Raphael Tito can be contacted via phone (904) 202-4600.

Contact Information

Primary practice address
841 Prudential Dr Ste 180 Attn: Credentialing Specialist Jacksonville FL 32207-8350
Phone: (904) 202-4600
Fax: (904) 202-4614
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 2013-01760 North Carolina
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X ME123543 Florida
Allopathic & Osteopathic Physicians / Geriatric Medicine 207QG0300X ME123543 Florida

Profile Details

NPI number 1972894921
LBN Legal business name Balbino, Raphael Tito
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 26th, 2011
Last updated Oct 17th, 2019 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1972894921 NPPES
Florida MEDICAID 014936900

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