Provider Demographics
NPI:1912940610
Name:GUZMAN FONALLEDAS, RAFAEL C (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:C
Last Name:GUZMAN FONALLEDAS
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 52024
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-2024
Mailing Address - Country:US
Mailing Address - Phone:787-565-4431
Mailing Address - Fax:
Practice Address - Street 1:2012 VIA PLAYERA
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-4357
Practice Address - Country:US
Practice Address - Phone:787-565-4431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2018-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9902207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine