Provider Demographics
NPI:1902265788
Name:GONZALEZ, RAFAEL JR (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:GONZALEZ
Suffix:JR
Gender:M
Credentials:APRN, FNP-C
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 749
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1614
Mailing Address - Country:US
Mailing Address - Phone:956-362-2171
Mailing Address - Fax:
Practice Address - Street 1:5111 S MCCOLL RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8278
Practice Address - Country:US
Practice Address - Phone:956-720-4721
Practice Address - Fax:956-362-3793
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX737418363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX357534201Medicaid
TX500802YNG9Medicare PIN