Provider Demographics
NPI:1174129373
Name:GONZALEZ-BARROS, RAFAEL ULISES (MD)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:ULISES
Last Name:GONZALEZ-BARROS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 368135
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-9135
Mailing Address - Country:US
Mailing Address - Phone:787-587-3545
Mailing Address - Fax:
Practice Address - Street 1:CARR 844, KM 0.5 CUPEY ALTO
Practice Address - Street 2:
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00928
Practice Address - Country:US
Practice Address - Phone:787-761-8383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22119208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice