Provider Demographics
NPI:1366480543
Name:SANTIAGO-GONZALEZ, RAFAEL ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:ANTONIO
Last Name:SANTIAGO-GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAFAEL
Other - Middle Name:
Other - Last Name:SANTIAGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33526-0099
Mailing Address - Country:US
Mailing Address - Phone:813-929-3609
Mailing Address - Fax:813-907-3111
Practice Address - Street 1:8819 RIVER CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-5132
Practice Address - Country:US
Practice Address - Phone:727-834-8833
Practice Address - Fax:727-834-8842
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96525208100000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAH786Medicare PIN