MEDICARE: DR. RAFAEL GONZALEZ DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0131X	Foot Surgery Podiatrist	000808	CT
2	213ES0103X	Foot & Ankle Surgery Podiatrist	000808	CT
3	213E00000X	Podiatrist	000808	CT

General Provider Information

NPI Number	:	1851349997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAFAEL GONZALEZ DPM

Provider Business Mailing Address
First Line	:	580 COTTAGE GROVE RD STE 203
Second Line	:
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-3088
Country	:	US
Telephone Number	:	860-263-7999
Fax Number	:	860-216-0664

Provider Business Practice Location Address
First Line	:	580 COTTAGE GROVE RD STE 203
Second Line	:
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-3088
Country	:	US
Telephone Number	:	860-263-7999
Fax Number	:	860-216-0664

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	03/17/2026

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