Healthcare Provider Details

I. General information

NPI: 1215933734
Provider Name (Legal Business Name): JUAN RAMON SILVA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO. LLANOS KM.0.4 CARRETERA725
AIBONITO PR
00705
US

IV. Provider business mailing address

PO BOX 1320
AIBONITO PR
00705-1320
US

V. Phone/Fax

Practice location:
  • Phone: 787-735-0079
  • Fax: 787-735-0079
Mailing address:
  • Phone: 787-735-0099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number8101
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: