Provider Demographics
NPI:1134102940
Name:GONZALEZ, EMILO RAFAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILO
Middle Name:RAFAEL
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8938
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-8938
Mailing Address - Country:US
Mailing Address - Phone:787-746-5993
Mailing Address - Fax:787-746-5993
Practice Address - Street 1:201 CALLE GAUTIER BENITEZ
Practice Address - Street 2:SUITE 303 CONSOLIDATED MEDICAL PLAZA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-5527
Practice Address - Country:US
Practice Address - Phone:787-746-5993
Practice Address - Fax:787-746-5993
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8512174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC82409Medicare UPIN