Healthcare Provider Details

I. General information

NPI: 1285702589
Provider Name (Legal Business Name): DR. ANGEL RAFAEL GONZALEZ PUJOLS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 10/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

C FONT MARTELO #104
HUMACAO PR
00791
US

IV. Provider business mailing address

BOX 304
HUMACAO PR
00792
US

V. Phone/Fax

Practice location:
  • Phone: 787-852-7514
  • Fax: 787-852-1514
Mailing address:
  • Phone: 787-852-7514
  • Fax: 787-852-1514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4430
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: