Provider Demographics
NPI:1215976782
Name:NIEVES GONZALEZ, LUIS RAFAEL (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:RAFAEL
Last Name:NIEVES GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 484
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-0484
Mailing Address - Country:US
Mailing Address - Phone:787-407-4424
Mailing Address - Fax:787-830-8866
Practice Address - Street 1:CARRETERA 2 KM 112.2
Practice Address - Street 2:BO MORA
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-4800
Practice Address - Country:US
Practice Address - Phone:787-830-8866
Practice Address - Fax:787-830-8866
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR15589208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice