MEDICARE: DR. RAFAEL GONZALEZ RODRIGUEZ 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	207PP0204X	Pediatric Emergency Medicine (Emergency Medicine) Physician	9989	PR
2	2080P0210X	Pediatric Nephrology Physician	9989	PR

General Provider Information

NPI Number	:	1407815269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAFAEL GONZALEZ RODRIGUEZ M.D.

Provider Business Mailing Address
First Line	:	621 NORTHCOAST VLG
Second Line	:
City	:	VEGA ALTA
State	:	PR
Zip	:	00692-8720
Country	:	US
Telephone Number	:	787-688-8375
Fax Number	:

Provider Business Practice Location Address
First Line	:	1451 AVE ASHFORD
Second Line	:	ASHFORD PRESBYTERIAN COMMUNITY HOSPITAL
City	:	SAN JUAN
State	:	PR
Zip	:	00902-0032
Country	:	US
Telephone Number	:	787-721-2160
Fax Number	:

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

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	02/18/2026

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