Provider Demographics
NPI:1285809137
Name:FERNANDEZ-GONZALEZ, RODOLFO ANTONIO SR
Entity type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:ANTONIO
Last Name:FERNANDEZ-GONZALEZ
Suffix:SR
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:RODOLFO
Other - Middle Name:ANTONIO
Other - Last Name:FERNANDEZ-GONZALEZ
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1708 AVE PONCE DE LEON
Mailing Address - Street 2:SUIT 202
Mailing Address - City:SANTURCE
Mailing Address - State:PR
Mailing Address - Zip Code:00909-1918
Mailing Address - Country:US
Mailing Address - Phone:787-728-6471
Mailing Address - Fax:787-727-7155
Practice Address - Street 1:1708 AVE PONCE DE LEON
Practice Address - Street 2:SUIT 202
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909-1918
Practice Address - Country:US
Practice Address - Phone:787-728-6471
Practice Address - Fax:787-727-7155
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1303103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical