Basic Information
| Provider Information | |||||||||
| NPI: | 1710603303 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARDONA GONZALEZ | ||||||||
| FirstName: | RAFAEL | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 177 CALLE S CARRION W | ||||||||
| Address2: | |||||||||
| City: | GURABO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007782525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7873683255 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | HIMA SAN PABLO | ||||||||
| Address2: | HOSPITAL HIMA SAN PABLO | ||||||||
| City: | CAGUAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007264980 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876533434 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2022 | ||||||||
| LastUpdateDate: | 10/14/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 9575028 | FL | Y | Nursing Service Providers | Registered Nurse |
No ID Information.