Provider Demographics
NPI:1235210287
Name:GONZALEZ-VIZOSO, RAFAEL A (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:A
Last Name:GONZALEZ-VIZOSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:505 S 336TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6328
Mailing Address - Country:US
Mailing Address - Phone:180-033-6861
Mailing Address - Fax:253-838-6418
Practice Address - Street 1:3455 S 344TH WAY
Practice Address - Street 2:SUITE 210
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98001-9560
Practice Address - Country:US
Practice Address - Phone:180-033-6861
Practice Address - Fax:253-838-6418
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00033490207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5971GOOtherBSWA
WA8187320Medicaid
WAP00370054OtherRRGA
WA0213580OtherLIWA
WA8862997Medicare PIN
WA8187320Medicaid