Provider Demographics
NPI:1487949533
Name:RICARDO GONZALEZ, ROBERTO RAFAEL (MD, PHD)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:RAFAEL
Last Name:RICARDO GONZALEZ
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 DIVISADERO STREET, 3RD FLOOR
Mailing Address - Street 2:UCSF DERMATOLOGY
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115
Mailing Address - Country:US
Mailing Address - Phone:415-353-7800
Mailing Address - Fax:415-353-7870
Practice Address - Street 1:1701 DIVISADERO STREET, 3RD FLOOR
Practice Address - Street 2:UCSF DERMATOLOGY
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115
Practice Address - Country:US
Practice Address - Phone:415-353-7800
Practice Address - Fax:415-353-7870
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA247616207R00000X
CAA123884207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine