Provider Demographics
NPI:1730292590
Name:PORTELA GONZALEZ, RAFAEL A (DMD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:A
Last Name:PORTELA GONZALEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 140794
Mailing Address - Street 2:ARECIBO
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-0794
Mailing Address - Country:US
Mailing Address - Phone:787-878-3039
Mailing Address - Fax:787-878-4038
Practice Address - Street 1:STREET 2 KM 80.1 ARECIBO MEDICAL CENTER
Practice Address - Street 2:SUITE 204
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-878-3039
Practice Address - Fax:787-878-4038
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2015-05-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR21051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice