MEDICARE: DR. EMILO RAFAEL GONZALEZ M.D.

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	174400000X	Specialist	8512	PR

General Provider Information

NPI Number	:	1134102940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMILO RAFAEL GONZALEZ M.D.

Provider Business Mailing Address
First Line	:	PO BOX 8938
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00726-8938
Country	:	US
Telephone Number	:	787-746-5993
Fax Number	:	787-746-5993

Provider Business Practice Location Address
First Line	:	201 CALLE GAUTIER BENITEZ
Second Line	:	SUITE 303 CONSOLIDATED MEDICAL PLAZA
City	:	CAGUAS
State	:	PR
Zip	:	00725-5527
Country	:	US
Telephone Number	:	787-746-5993
Fax Number	:	787-746-5993

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

Provider Enumeration Date	:	11/25/2005
Last Update Date	:	07/08/2007

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