Basic Information
| Provider Information | |||||||||
| NPI: | 1487949533 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RICARDO GONZALEZ | ||||||||
| FirstName: | ROBERTO | ||||||||
| MiddleName: | RAFAEL | ||||||||
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| Credential: | M.D., PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1701 DIVISADERO STREET, 3RD FLOOR | ||||||||
| Address2: | UCSF DERMATOLOGY | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4153537800 | ||||||||
| FaxNumber: | 4153537870 | ||||||||
| Practice Location | |||||||||
| Address1: | 1701 DIVISADERO STREET, 3RD FLOOR | ||||||||
| Address2: | UCSF DERMATOLOGY | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4153537800 | ||||||||
| FaxNumber: | 4153537870 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2011 | ||||||||
| LastUpdateDate: | 02/11/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 247616 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207N00000X | A123884 | CA | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.