Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 10046 | PR |
NPI | 1124077649 |
---|---|
Provider Name | Dr. Antonio Rafael Gonzalez |
First Address | Caguas, PR 00726 |
Second Address | Caguas, PR 00725 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 08/07/2007 |