Provider Demographics
NPI:1972534501
Name:GONZALEZ, RAPHY ALEXIS (MD)
Entity Type:Individual
Prefix:DR
First Name:RAPHY
Middle Name:ALEXIS
Last Name:GONZALEZ
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:PO BOX 141322
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-1322
Mailing Address - Country:US
Mailing Address - Phone:787-820-0553
Mailing Address - Fax:787-820-3232
Practice Address - Street 1:CARR #130 KM 5.4 BO NARANJITO SECTOR LECHUGA
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-9415
Practice Address - Country:US
Practice Address - Phone:787-820-3232
Practice Address - Fax:787-820-3232
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15225208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI33657Medicare UPIN