Basic Information
| Provider Information | |||||||||
| NPI: | 1407815269 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GONZALEZ | ||||||||
| FirstName: | RAFAEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 621 NORTHCOAST VLG | ||||||||
| Address2: | |||||||||
| City: | VEGA ALTA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006928720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876888375 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1451 AVE ASHFORD | ||||||||
| Address2: | ASHFORD PRESBYTERIAN COMMUNITY HOSPITAL | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009020032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877212160 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2006 | ||||||||
| LastUpdateDate: | 07/29/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PP0204X | 9989 | PR | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Pediatric Emergency Medicine | 2080P0210X | 9989 | PR | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Nephrology |
No ID Information.