Basic Information
| Provider Information | |||||||||
| NPI: | 1063471829 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GONZALEZ CASTRO | ||||||||
| FirstName: | RAFAEL | ||||||||
| MiddleName: | ANGEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 619 S MARION AVE | ||||||||
| Address2: | |||||||||
| City: | LAKE CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320255808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3867553016 | ||||||||
| FaxNumber: | 3867546352 | ||||||||
| Practice Location | |||||||||
| Address1: | 619 S MARION AVE | ||||||||
| Address2: | |||||||||
| City: | LAKE CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320255808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3867553016 | ||||||||
| FaxNumber: | 3867546352 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2006 | ||||||||
| LastUpdateDate: | 04/19/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 12332 | PR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 20469 | 01 | PR | TRIPLE SSS | OTHER | 300115 | 01 | PR | MMM | OTHER | A-040 | 01 | PR | FIRST MEDICAL/ IMC | OTHER | 03827 | 01 | PR | AMERICAN HEALTH | OTHER | 100649 | 01 | PR | CRUZ AZUL | OTHER | 200-365 | 01 | PR | PREFERRED HEALTH | OTHER | 36-0306-7 | 01 | PR | ACAA | OTHER | PE-4847 | 01 | PR | PALIC | OTHER | 716-0040 | 01 | PR | HUMANA HEALTH PLAN | OTHER | 115-12332 | 01 | PR | GLOBAL HEALTH PLAN | OTHER | 20469 | 01 | PR | AUXILIO PLATINO | OTHER | 3612332 | 01 | PR | UIA | OTHER | 3883 | 01 | PR | PREFERRED MEDICARE CHOICE | OTHER |