Provider Demographics
NPI:1306158191
Name:GONZALEZ-PUPO, RAFAEL A (MD)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:A
Last Name:GONZALEZ-PUPO
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 1:9940 SW 62ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1432
Mailing Address - Country:US
Mailing Address - Phone:786-894-6513
Mailing Address - Fax:
Practice Address - Street 1:7150 W 20TH AVE STE 615
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5511
Practice Address - Country:US
Practice Address - Phone:305-691-4806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME160096208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)