Healthcare Provider Details

I. General information

NPI: 1306158191
Provider Name (Legal Business Name): RAFAEL A. GONZALEZ-PUPO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 SW 62ND AVE STE 600
SOUTH MIAMI FL
33143-4728
US

IV. Provider business mailing address

7000 SW 62ND AVE STE 600
SOUTH MIAMI FL
33143-4728
US

V. Phone/Fax

Practice location:
  • Phone: 305-228-4675
  • Fax:
Mailing address:
  • Phone: 305-228-4675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME160096
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: