| Doctor Name: | MR. RODOLFO GONZALES SAN JUAN |
| NPI Number: | 1306031232 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RN |
| License Number: | 00006824 |
| Business Practice Address: | 480 Central Ave Naval Health Clinic Hawaii Pearl Harbor, HI - 968604908 |
| Business Phone Number: | 8084731880 |
| Business Fax Number: | 8084734411 |
| Mailing Address: | 480 Central Ave, Naval Health Clinic Hawaii PEARL HARBOR |
| State: | HI |
| Postal Code: | 968604908 |
| Phone Number: | 8084731880 |
| Fax Number: | 8084734411 |
| NPI Enumeration Date: | 09/13/2007 |
| NPI Last Update Date: | 09/13/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 247100000X |
| License Number: | 00006824 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WA |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Radiologic Technologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is trained and qualified in the art and science of both ionizing and non-ionizing radiation for the purposes of diagnostic medical imaging, interventional procedures and therapeutic treatment. |