Individual
MR. RAFAEL MEDIAVILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S-ESL
Contact information
Practice address
33 RENWICK DR, BRIDGEPORT, CT 06604-2037
(203) 612-4870
Mailing address
33 RENWICK DR, BRIDGEPORT, CT 06604-2037
(203) 612-4870
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1664735
NY
Other
Enumeration date
03/13/2013
Last updated
03/13/2013
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