Healthcare Provider Details

I. General information

NPI: 1740431030
Provider Name (Legal Business Name): RAFAEL ALBERTO GONZALEZ PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2008
Last Update Date: 06/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 AVE DOMENECH OFFICE 108
SAN JUAN PR
00918-3523
US

IV. Provider business mailing address

512 CALLE WILLIAM JONES
SANTURCE PR
00915-3435
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-3029
  • Fax:
Mailing address:
  • Phone: 787-460-4733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number2984
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2984
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: