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General NPI Number Information
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NPI Number | 1306031232
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Entity Type | Individual
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Provider Name | RODOLFO GONZALES SAN JUAN RN
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Gender | Male
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 9300 DEWITT LOOP BLDG 1203
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City | FORT BELVOIR
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State | VA
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Zip | 22060-5285
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Country | US
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Telephone | 571-562-0444
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Fax |
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Provider Business Mailing Address
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Address Line | 9409 STIMSON RD BLDG 8151
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City | FORT BELVOIR
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State | VA
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Zip | 22060-2225
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Country | US
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Telephone | 703-805-0113
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SC0200X
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Taxonomy Name | Critical Care Medicine Clinical Nurse Specialist
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License Number | 2000643163
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 50652
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License Number State | HI
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Taxonomy #3
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Taxonomy Code | 163WG0600X
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Taxonomy Name | Gerontology Registered Nurse
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License Number | 20200099687
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License Number State | MD
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