Healthcare Provider Details

I. General information

NPI: 1689117814
Provider Name (Legal Business Name): MARIO A RAMOS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2016
Last Update Date: 01/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 URB LOS FLAMBOYANES
ANASCO PR
00610-2105
US

IV. Provider business mailing address

25 URB LOS FLAMBOYANES
ANASCO PR
00610-2105
US

V. Phone/Fax

Practice location:
  • Phone: 787-238-2648
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number3077P
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: