Provider Demographics
NPI:1174869457
Name:POLO, RAFAEL ARCANGEL (SA-C)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:ARCANGEL
Last Name:POLO
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15125 WEST RD
Mailing Address - Street 2:APARTMENT 921
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095
Mailing Address - Country:US
Mailing Address - Phone:832-863-0984
Mailing Address - Fax:281-628-0471
Practice Address - Street 1:15125 WEST RD
Practice Address - Street 2:APARTMENT 921
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095
Practice Address - Country:US
Practice Address - Phone:832-863-0984
Practice Address - Fax:281-628-0471
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant