Provider Demographics
NPI:1699296319
Name:GO, RAFAEL FRANCISCO CHUPECO (MD, MBA, MS)
Entity type:Individual
Prefix:DR
First Name:RAFAEL FRANCISCO
Middle Name:CHUPECO
Last Name:GO
Suffix:
Gender:M
Credentials:MD, MBA, MS
Other - Prefix:
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Mailing Address - Street 1:PO BOX 3539
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86405-3539
Mailing Address - Country:US
Mailing Address - Phone:928-453-2727
Mailing Address - Fax:
Practice Address - Street 1:2082 MESQUITE AVE STE A
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-6710
Practice Address - Country:US
Practice Address - Phone:928-453-2727
Practice Address - Fax:928-453-2828
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301509437207RI0011X
IL125070077207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine