Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | 9989 | PR |
Y | 2080P0210X | Pediatric Nephrologist | 9989 | PR |
NPI | 1407815269 |
---|---|
Provider Name | Dr. Rafael Gonzalez |
First Address | Vega Alta, PR 00692-8720 |
Second Address | San Juan, PR 00902-0032 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 29/07/2015 |